1st Nursing job, seeking some advice

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Quick background, 43, this is a 2ns career start. Just hired for medsurg, night shift (3/12's) at a reputable hospital one town over (60mile commute one way, joy! But I have friends that might let me crash overnight now and then...). Passed NCLEX back in Dec '13, and this is the 1st job offer I have gotten in that time, so I jumped on it.

Here is my problem, I have not seen or touched a pt. in 6+ months. On top of that, the hospital where I did my clinicals is in a predominantly older community that has a good bit of $ (wants pts to believe they are at a spa, go Hcap scores!). The nurses that we did clinicals under wanted us doing bed baths, linen changes and to walk pts around the floor 99% of the time. Both I and my clinical instructor caught heat because the last few weeks of clinicals I asked to be assigned to the clin2 on our floor and stated that I wanted to follow her to watch what she did, see how she prioritized, time-managed. By the end of the week the clin2 complained to the unit mgr. that our time would be better spent on bed baths, etc. etc. From a work perspective, I feel our clinical time was almost (not all) wasted. I feel totally unprepared to start this new job.

My question, if you were a preceptor what kind of things would you expects a new grad to know walking in the door? I know I am expected to be new and with no previous medical background/experience my knowledge is expected to be... basic. Right now I do not even feel I am at a "basic" level. Can anyone recommend some reading; you tube videos, a good website for good practical and useful info? I am a pretty quick study, I am good at time management, when I know what I am doing and I am not afraid to ask for help when I feel I am in over my head. I do not want to try to be some rock star on the floor; I just want to seem totally incompetent starting the new job.

Any advice is appreciated.

Thanks

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Specializes in Critical Care, Education.

You seem to be very humble, conscientious & determined to be successful - that's a wonderful asset in any new grad.

No one expects a new grad to function independently for quite a while. However, you should know when to ask for help. This means recognizing when patient safety is at stake and intervene appropriately - whether it is an unexpected change in vital signs, change in level of consciousness, non-cooperation (pulling IV, NG, climbing out of bed, etc) or subtle changes that just seem "different". Those interventions could range from notifying your preceptor (in the early days of orientation), to calling a physician or triggering the rapid response team.

Your need to clearly understand and follow all of the 'normal' protocols & care pathways for the most common diagnoses on your unit. It may help to outline your own care plans to serve as a guide - just like you did in nursing school. Don't hesitate to utilize available resources - such as chaplains, case managers, social services, dietitians & pharmacy when you need them. It makes a lot more sense to make a 5 minute call to pharmacy than spend 20 minutes trying to figure out precautions for an unfamiliar med.

Don't hesitate to ask questions if you don't understand. Even if it is a physician, you need to advocate & keep your patient safe at all times. Johns Hopkins developed a really effective model called "CUS" that helps with this type of communication. C= "I am concerned about _____" to open the discussion in a non-threatening way U= "I am uncomfortable with _____" S "This is a safety issue" include specifics.

Don't worry too much about technical skills - with sufficient opportunity to practice, you will master them. Time management will fall into place as you learn to prioritize effectively. Stay humble. Be courageous; don't ask for help unless you really need it... not just for validation or reassurance. Strive to maintain an open, non-defensive response to critical feedback.

You're going to be a great nurse.

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HouTx, thanks for you're reply. I am in a similar situation as icarr757. I am a second career nurse in my early 40s. I start me first RN job in a couple weeks and am feeling anxious because I have not touched a patient in 7 months and passed the NCLEX 5+ months ago. I feel like all my knowledge has been draining out of my head over the last few months as I have been looking for work. I am fortunate to have found a job in a med/surg unit that is close to home. It is a teaching hospital and Magnet facility, so I am anticipating I will receive good orientation/training. I keep telling myself that once I start I want to stay positive, confident (yet humble), and absorb as many learning opportunities as possible. I also expect to have tough days and setbacks, but I must remind myself to push through these so I can continue to learn and improve. I don't know if it will help, but I am reviewing my NCLEX study materials. If anything it keeps my mind busy and makes me feel like I am doing something to prepare.

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I felt the same way in nursing school. I also once tried to shadow a nurse to see what she does, how she organizes her day, and assess her patients with her, and was told by my INSTRUCTOR that I couldn't because I had bed baths to do.

Congrats on your new job. You'll learn a lot. I'm sure they're used to new nurses being in your position, and they hired you because they see potential in you.

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