Rn new grad help

[Dani_2018]

Hello! I am starting in the CVICU in july and I am beyond excited but I am fully aware I have a lot to learn and am prepared to do so. I am just kind of wondering starting off when you go into your patient's room you and get a full head to toe assessment introduce yourself and make sure the patient doesn't need anything what is next as in what do I do ? What do you do when you go in does it matter according to where you work if you check labs or what the steps would be? Im trying to connect everything and I know it will come in time but I would love to have an idea of what I should be doing.

Thank you

[mejsp]

My motivation is to do the chore I like least first. When you get that out of the way everything else is easier. My least favorite chore is CHARTING. Maybe you did that electronically while performing the assessment? Are there medications to pass? I'd pay attention your most efficient co-worker and follow his or her example.

[SanJose_FNP]

As a new nurse, I suggest to go to work a bit early to find out your assignment and prepare well for it. I did that as a new grad, and it helped greatly.

[Charge200J, BSN]

So when you start orientation you will follow your preceptor's lead in terms of a shift timeline. Obviously when two patients are coding on opposite sides of the unit in the middle of shift change, the delirious pt is trying to jump out of bed, and it feels like the sky is falling then this timeline goes out the window and you just all work together to make it through.

But here's a rough idea of the general flow of my shift:

1900 clock in and look at assignment board. Know who your Charge RN is. Know who your PA/NP/MD's are for the shift. Print off our EKG strips & begin bedside report.

1930 If I have two patients then I go eyeball my sicker pt first. If I have a 1:1 then I go directly to my pt. Check high risk gtts/mechanical assist devices and introduce self to family & pt.

From there on each hospital and unit has their own policies but we do:

Q4hr full head to toe assessments (20:00, midnight, 0400), Q4hr EKG strip or more often per pt situation. Q2hr turns, Q1hr I/O's. Depending on the pt situation and mechanical assist devices there could be frequent vascular checks/neuro checks/chest tube/drain outputs/cardiac output numbers, blood sugar checks etc. Meds are squeezed in there and you manage any acute changes in your pt throughout the shift.

0300 AM labs. We do AM labs early so you have time to transfuse/replace electrolytes/etc before shift change. (you may do labs more frequently depending on pt situation).

0500 - 0700 CHG bath/linen change/dressing changes. Wrap up charting, change IV tubing, morning chest xray & 12 lead EKG, clean up room/prep for shift change. If your pt is stable enough to sit upright/don't have any restrictions then they will get up in the chair (we have awesome ceiling lifts in each room).

That's the general idea. But on your first day all you have to do is show up, find where to put your lunch box, find your preceptor and stick to them like glue. Take lots of deep breaths/eat/hydrate and you will be just fine. :)