Suggestions for the Med-Surg First Job

[NepRN]

Hi All,

I landed a med-surg position finally after 6 years. But since I am not a fresh new grad, a lot of things are rusty for me. I took refresher course, but even such classes can't really make you ready to work in a hospital. I would really appreciate if you can suggest techniques on few usual things done in a med-surg floor. Any suggestion/help will help me transition into an experienced RN. I am very nervous about many things like different syringes, medications, feeding pump, drainage tube, IV etc.

Thank you!

[LouisVRN, RN]

This is not an easy question to answer as we tend to see it all.

Feeding tubes should have a policy and they should cover their use in orientation, but honestly in 3 years of working med-surg I've had a feeding tube maybe half a dozen times. TPN/Lipids are much more common for our patient population.

The most common types of drainage tubes we see are Jackson-Pratts to bulb suction, but occasionally will see a T-tube, hemovac, chest tubes, accordian drains, NG tubes, etc. The most important thing is to look up the facilities policies and reference the physicians orders and call if you ever have a question.

Not really sure what you mean about syringes. We usually will use a 3-5 cc for medications/heparin, and a 10cc for medications that need to be diluted or for line draws. Anything above that is pretty much used only for Foley irrigation/aspiration.

IVs are pretty simple once you learn the pumps. We usually have a primary line, IV antibiotic piggybacks and occasionally another piggybacked line for electrolyte replacement. We also use a lot of PCA pumps/OnQ pumps, femoral nerve blocks and its important with these to follow the anesthesiologists orders over the surgeons.

Our floor we see a lot of Lap Appys, Choles, Hernia repairs, TKA, THA, ORIFs, pelvic fxs, occasionally we will also get GYN/GU pts for TURPs, Hysterectomies, prostectamies, nephrectomies, etc. i would definitely ask about the most common admitting dxs for your unit as it will help you to prepare.

[Yiggs]

Congratulations! I would think you will be on orientation for a while with a preceptor. Each hospital's policies, proceedures, protocols and equipment might differ somewhat. If I were you I would make a list of 'things' that I am not comfortable with or have questions about and make sure you mention it to your preceptor. Ask for a little more coaching and practice with proceedures you are not comfortable with. Also, try not to shy away from doing proceedures because of fear; offer to help other nurses who are skilled at what you are not comfortable with and in time you will feel more comfortable and skilled. Their are some basics that are the same throughout all hospitals like checking for residual before you give tube feeding. You could get a lot of information from browsing the web looking up evidenced based papers tube feeding, insertion of foleys etc. Lastly, ask for clarification when you are not clear on what to do!

[NepRN]

Thanks to both of you! It's true I should make a list of things I am not comfortable with. The things you mentioned above are a big help for me to get started with my list. Thanks again!