Boston7

Dear BettyBoop01, My first thoughts are: you have a sense of play about you, and you chose the # "1" which tells me you strive to achieve~! Establishing one's self as a new nurse is critical in the first year. It requires empowerment on your part. Knowledge = power; time & experience = confidence. There is a book in print entitled "The Everything New Nurse Book" by Kathy Quan, RN, BSN, PHN. You can order it via the web @ www.adamsmedia.com. While a lot of the material is review, there are many pointers. Be gentle to you, alter your perception of your work environment, be mindful of why you decided to become a nurse. The confidence will come as you gain experience. I've no doubt you have what it takes to be on Med-Surg; afterall, you made it through nursing school and you passed your Boards~! That being said, try to take a focused approach to patient care. Apply those 'critical thinking' skills not only to your nursing practice, but also where your colleagues are concerned. Each and every nurse you are working with, has been in your shoes, and indeed survived. Sometimes a gentle reminder can go a long way. If you are 'getting chewed out in report' - empower yourself~! Take a look at what is being stated, the tenor and demeanor of the nurse. Is it a 'nurses eat their young' type gratification? If so, take some really deep breaths, desensitize, take from the lesson what is beneficial and let go of the rest. You have major adjustments on your plate, i.e., you've relocated to accept the position for one. You're on a med-surg unit for another. You may be cut off from a support base as well. Consider the following: what can you do to affect positive change on a shift-by-shift basis? Can you incorporate humour when you feel under attack? What can you do, when under pressure, to refocus in the circumstance? Acceptance comes with time and perhaps a 'few nibbles just because". Empower yourself with the knowledge that you have something substantial to contribute. Focus on patient care vs. winning the approval and acceptance of those nurses you work with. Afterall, you're not in nursing to win out a 'personality' contest. If you are unsure and want to pose a question, change your approach. For example, you might say " {Nurse} Elly, I value your input, tell me what you think about...?". If you appear ill-confident and unsure, then you leave the field wide open. Remember the commercial "never let 'em see you sweat"? Hang tough, you CAN do it. What you are unsure of, review and recheck. Think before you speak. When you do speak, speak with articulation, confidence and authority. You state you 'don't think you're capable of handling six+ patients on your own'. Why are you feeling as such? What do you base this on? Newness to the profession? How can you effectively rally support during a shift, ask for help effectively, and go home feeling good about the given shift, not to mention being a nurse? Apply your psych knowledge and skill in your present venue. Regroup and apply the nursing process to your working environment. If, after careful consideration, you feel med-surg simply isn't for you, explore other possibilities with your employer. You sold yourself during the interview and landed the job right? You've no doubt a lot going for you, be you and be upbeat. You are not a 'victim' and while you may be vulnerable with unsure footing, that footing will strengthen with time. Seek out a mentor if one is available and communicate with this individual often. Taking it one shift at a time is wise. Three shifts in a row is not. Seek a healthy balance in the day-to-day. When you are not working, what are you doing that is good for you? There's more in a day than just what you do as a vocation. What you do as a vocation, is not necessarily who you are inside. Shine from within and celebrate you, your achievements. Look to the future, set short-term and long-range goals and put your plan into action. You'll get there with time, patience and perserverence. Weakness is NOT in your vocabulary. Success is~! With every best wish, I am - and Happy Thanksgiving~!

Hi Wahini - that's wonderful you decided to do~! I know the feeling - tore my rotator cuff - having surgery soon and know it will be a bit of time before I can return - will say never gave it a thought that I'd injure myself in the course of duties - ah well, is what it is - we move on~! :) Best wishes and happy travels~!! Nansea :redbeathe

Great advice - you're absolutely right - use one's age to the maximum as there's one ingredient we have the younger ones do not - "a healthy balance of life's seasonings"~! :)

Dear Eyeball ~ Congratulations~! I completed an LPN program in 2008, I was 54 at graduation. Ok, so I should have invested an extra year and done the RN route, but hindsight is always 20-20~! Being an older nurse affords much in terms of patient care. An older nurse who projects his/her self as professional will gain much trust from the older generation patient. Life experience goes a long way as well in terms of overall assessment. If I could give you advice, I would tell you the following: 1. Be confident in what you know - what you don't know - watch, listen & ask. 2. Don't get caught up in the gossip. Keep personal info to a minimum, the less they know, the better when it comes to one's personal life. Just sit back, watch, listen, observe - you'll find out soon enough who's who, in whom you can trust, etc. Think before speaking goes a long way as well. 3. Be a team player, do your best to work in concert with fellow nurses. 4. Develop/possess time management routines - be organized - stay focused - anticipate - cross t's & dot i's. Every nurse develops his/her own routine & style that works, identify yours & stick with it. 5. Know facility P&P. Follow chain-of-command protocols. 6. Carry a small notebook in your pocket to jot important things into - I have met many RNs who, when unable to remember something, reach into their pocket and pull out little composition books - filled with quick reference notations. 7. Choose a mentor and touch base often; use this individual to vent frustration, seek alternative approaches, etc. 8. Recognize that there's always going to be someone who won't react favorably toward you, do your best, move on. One may not always know what's going on with an individual in terms of the outside, or even in the workplace. 9. Know when to delegate & know your staff - when one is frazzled - offer positive solutions. Active listening hits home here. 10. Know UAP scope of practice and LPN scope of practice. 11. Know your own self - your strengths - your weaknesses - continually educate yourself - when in doubt, check it out :) 12. Have fun - humour goes a long way - particularly in high-stress environments. 13. When stressed - take a step back for a minute or two - clear your thoughts, remove emotion - refocus & get back to task at hand. 14. Take care of you~! Make sure you've a healthy balance in the day-to-day - eat well, wear comfy & supportive shoes, drink plenty of fluids - get plenty of rest - don't sign up for extra unless you're absolutely up to the task. Too much OT drains one over time. Be "gentle to you" at all times~! While I'm sure you've incorporated all the above in one form or another, I hope this helps you. I've been in LTC environments for the past 20 months and it's been an 'eye-opener' for sure. Don't be intimidated. Younger nurses are a different breed in some respects (I mean no offense here). At one time or another, you may pose a threat to fellow nurses simply by being you. Nurses eat their young, mostly when given the opportunity - why.... well....because they can (if one lets them)....because they've forgotten when they were new to nursing....because there's a sick humoured-side to getting a nibble perhaps...this should not be and as a new nurse you will learn when to stand up for you & pick your battles wisely. I was a paralegal for 23 years, well regarded, well respected - I worked with the toughest of the tough. I do have to admit, however, that in nursing, working with predominantly women, it's a very competitive and catty environment at times. Competition is healthy when constructive and well-balanced. Lastly, always remember your 1st responsibility is to YOU - protect that which you've worked so hard to attain - your LICENSE~! If a mistake has been made, admit to it, correct it and move on, afterall, no one of us is perfect and we are always subject to human error. Right? :) I wish you the absolute best - you haven't made it this far afterall - and you've much to contribute~! Blessings, Nurse Nansea

You are very wise to do especially if you're comfortable in the work environment...only caveat I'd say is with role change...yet I can tell you'll be 'right at home'~! Best regards to you and your successes. Nansea

Indeed, this is true. I'm 55...I have moments of joy...most times...stress levels off the charts, too much work between med pass, tx, charting & documentation + reports, etc. - long hours - coping w/call-offs - BUT - there are moments when I know I've made a difference for those WIMC...this is what propels me forward I guess...keep up the good work I've no doubt you're doing...give it time...before you leap...best wishes...Nansea

Thank you very much :) Nansea

Thank you as well for your comments...utilize network support...continue to plug along...do consider furthering on to RN...options are out there and it takes time to find one's niche...gut instinct tells me a new grad may go through 8-10 jobs at the onset to find the right venue. Like you, I struggle along and am considering the RN route as well...meanwhile, we learn as much as we can, realising that each position we are Blessed with...lends more experience, greater confidence levels and increases and/or solidifies knowledge...one thing for certain...we learn what is not right for us...keep your options open...test your marketability...keep searching...keep smiling & keep shining. You're a nurse and you've much achievement to get to where you are today...baby steps all the while :) Nansea

Thank you Chery~! :) Nansea

You've passed your Boards...you're excited with the prospects of being a nurse, your earnings potential, etc., etc. You've no experience and you muster through interview after interview. Then you get a phone call and are offered a position at a LTC facility. You accept. You're eager, enthusiastic and excited. Sound familiar? What you soon discover is that nursing in the "real world" is not exactly everything you learned in nursing school. You quickly become overwhelmed and question whether you know anything at all...you're not even sure how you passed your nursing boards after a few weeks~! Alrighty then...let's take a look-see at LTC nursing based upon this writer's experiences. You spend 1-3 days in corporate orientation. Next begins shadowing (orientation) on the floor & med pass. The nurse may be an RN or an experienced LPN. She may enjoy teaching...or...she may view you as a burden given her shift responsibilities. You sit in or report...you listen, observe and make any notes you deem appropriate. After report, you follow the assigned nurse and med pass begins. You're thinking...this looks easy...it can't be all that hard~! Really? As your orientation develops you're beginning to realize just how great the responsibility is and just how little time you have to complete your med pass, do your treatments, chart and document plus the myraid of incident reports and comprehensive evals you need to complete...oh, yes...and then there are the "emergencies"...and the lack of UAP's...and the call-offs. Uh-huh...it's starting to get real now and hit home right? In candor, your first two or three months are a roller-coaster of what not-to-dos and learning the key players. You will see the "right thing" and you will see a host of "shortcuts". Ultimately, it is up to you to always know and do the right thing. Are there consequences for the choices you make during a given shift? You bet your life there are~! You arrive home after a very long 12+-hour shift and then you begin to reflect on the day's events. What did you do right. What did you forget. What didn't you do. How did you handle a given situation. Did you do all the requisite charting - remember, 'not charted, not done'. You're tired, you're feet hurt and mentally you're feeling the strain and asking yourself what you've gotten yourself into. Here are some do's & don'ts: Do take your breaks and eat lunch during your shift - you need to replenish, you need fluids, restroom stops but most of all you need a few minutes to "regroup" your thoughts and re-focus. Do ASK QUESTIONS~! There are NO stupid questions. Errors or omissions do not count as "ignorance is bliss"...ASK for clarification...ASK for help...ASK to see a particular procedure...ASK...ASK...ASK. You may not be received with open arms but ask anyway. DO learn to stand up for yourself. Be ASSERTIVE but don't be aggressive. DO keep the lines of communications open as between you, other nurses, your charge nurse or supervisor, the ADON and the DON. DO try to observe and learn who you can go to...who you can ask to mentor you...who will be there when possible. It will not be easy and the old adage "nurses eat their young" will stare you in the face at nearly every turn. What peeves me more so though in this vein is the little "tips" nurses can give or show you to make your job easier and go more smoothly. Oftentimes, nurses will keep these "aces" in their sleeves until you've proven yourself and "paid your dues". DO ask for written updates on your performance and progress. While your requests may be shuffled under the carpet, if you can get it in writing, you have a legitimate guide to work from and later compare as you progress. DO find out which residents have appointments or are going out of the facility and the times...you need to know this PRIOR to the start of your med pass in terms of time management and smooth progression. DO ID your patient's wristbands - and get to know each resident on your floor/wing. It comes with time but it is key to your completing a timely med pass. Know a resident's preferences and idiosyncrasies is a huge timesaver and helps to build trust and rapport as between you and your resident. DO research and know your medications and respective side effects. Generally, you will need to figure out a way to list them and research them on your own time. Keep the list handy for reference. DO keep a notepad in your pocket along with 2 black ink pens, a red ink pen, a sharpie, and a hilighter. You also need your scissors, pen light and stethoscope. Use your drug handbook and 'when in doubt - check it out' beforehand. DO NO HARM - this is the cardinal rule. DO LISTEN to your residents - assess orientation, skin, neuro-musculo functions while you are giving each resident his/her medications. DO report absnormal findings to your charge nurse for follow-up. Learn to question if a resident doesn't seem right to you. DO trust your gut instinct~! What is it telling you? Listen to it and act on it when appropriate. DO try to chart as you go - if you leave charting til the end of the shift - you are out of time and scrambling not to mention you may not remember all the details. Chart precisely, accurately and factually. Use measurements or something which draws a mental picture. For example, you've done a wound dressing change...you didnt' measure it but it was the size of a dime...this is better than "dresssing changed per physician order" which is ambiguous on its face. Remember, the medical record is a legal record. Only the facts Ma'am...just the facts. DO complete your treatments. Do READ what you are signing off when charting in the treatment records...don't just initial~! DO ensure your Narcotics book is properly signed off - when you take a narcotic from your drawer, after it's been given, sign not only your MAR but be sure to sign in the Narcots Log Book as well. Chart by the rules - if you do not know them - ASK. Most nurses are only to happy to guide you and instruct you in this area. DO chart legibly and include your title. Progress/Nurses Notes should always denote date & time and be written in proper order. Late entries should indicate "late entry". DO ensure you are charting in the correct resident chart. DO thank your UAPs, dietary, housekeeping and any other ancillary personnel after they have lent assistance. This can go a long way and helps to build respect and rapport. Also, thank those nurses who've help you during your shift. Be sincere and genuine~! DO LAUGH and have FUN. Find ways to bring humour into your daily working routine. I'm sure I've left numerous other things out ... it's a start tho. Now on to the DONT's: DONT violate HIPPA or resident confidentiality - know your facility's policies & procedures - KNOW WHERE THE MANUAL is KEPT - consult it OFTEN. DONT participate in gossip or comment on staff members. Keep your opinions to yourself - MUM's the WORD here. Listen and observe - but do not join in EVER. DONT hide your mistakes or cover up. Be HONEST and ADMIT to your MISTAKES as soon as you discover them. Remember, you are a professional nurse and you must maintian your own integrity and reputation. DONT make accusatory remarks or "tattle-tale". This breeds animosity among other things. DONT call off unless you are genuinely ill. DONT show up to work late - always be 15-minutes or more early. Be ready and prepared for each shift before you start your shift. DONT usurp the chain of command - learn who's who - and follow accordingly. DONT be afraid to introduce yourself to physicians. Make eye contact, smile and be pleasant. You may not know the physician(s) but I guarantee you he/she does know who you are~! DONT do a procedure you are unsure of or not competent to do. An example would be starting an IV when you have not been checked off on the procedure by the Nurse Educator. Remember, 1st do no harm. DONT whine or complain about your workplace while on shift. It wastes valuable time and breeds animosity & contempt. DONT take on more than you can handle with regard to working extra shifts, etc. If you do too many and wear yourself thin, you've only done yourself and your facility a disservice. This writer has worked in LTC for a brief time and in no way means to come across as having all the answers. Time-management, communications, observations, active listening and a sense of self, having confidence in your own abilities - are all essential for overall success. Remember why you are there...rejoice in the rewarding moments...and at the end of a very long day, know you've done your best. If you are doing it right from the get go, it won't matter who walks through the door - you'll be doing as you should. This writer underwent the scrutiny of the watchful eye of State Inspectors as a new grad and new nurse. It was reinforcement that "yes, I'm a nurse...professional, diligent, text-book, caring...yes, I did it - and so can you~! Nursing is demanding and comes with high levels of responsibility. The hours are long. The pay short. It can be unforgiving and it can be filled with great humankind rewards. It comprises a league of men and women who are dedicated, professional, educated, skilled, and always learning. Continue to educate yourself in every way you can. Choose your mentors wisely. Network. Join chatrooms for nurses. Become a member of professional nursing organizations. GET MALPRACTICE INSURANCE - protect yourself. Susbcribe to magazines. Talk to your Pharmacist when in doubt r/t medications. Follow the Rights of Medication Administration - ALWAYS. Don't ever lower your standards or settle for that which you know you shouldn't. Aim high...be strong...confident...poised and respectful. Remember, it's not always who you know...it may very well be 'who knows you'~!! Respectfully, I am to all in the forum. I welcome your comments, thoughts, suggestions. Thank you.

I too am a new grad with just under 6 months experience. Does it get easier, I surely hope so...remember...we have a "choice" to view things as stress or as frustrating...we must choose to "focus" on who it is we serve...our patients...which is why we've become nurses~!