Survival Tips for First Year Nurses

purplemania, BSN, RN · Apr 23, 2004

CNTRN is right. The gossip mill can be deadly and could damage your career.

One good question to ask experienced nurses is "How do you manage your time?". I have seen novice nurses get stressed out over this issue. You have to learn how to prioritize.

Town & Country · Apr 23, 2004

I am pasting this from elsewhere. It needs to be posted here, too. Hope it helps.....

"I hear your pain. Having been a nurse for 32 years now, I have my share of horror stories. One in particular comes to mind similar to yours where a 46 year old man, husband and father, brother and son came into the ER with SOB. Was turfed too soon to our large medical unit that was staffed by 3 new grads. Me an ADN, a diploma grad and a BSN grad all green with the newest of us only out of school a month ago and the oldest out 3 months. The man was in pulmonary edema, even I knew that, and it was the month that all the new interns were on. It was late PM shift. The man should have been given Lasix in the ER before transfer, but did not. He was going downhill, and we were waiting for the Intern to come to the floor. We had RT there, we had the crash cart there, I even had the Lasix out and draw, we called down the nursing supervisor, but no Intern. We called him stat 3 times. I begged the supervisor to give me permission to give the Lasix. She refused. Back then, nurses could not ever take it upon themselves to push any kind of med without the docs permission. The intern finally came, the man was purple and now almost too worn out to breath, and the Intern did not know what to do and would not let me give the Lasix until her checked with the Medical Resident on call. Then he still waited for the Resident to come to the floor. Seconds before the Resident arrived, the man coded and we lost him. That was 32 years ago, and I still can see the man and the fear in his eyes. Today, I push meds without the doctor there. I wish I had been a seasoned nurse back then and had the "balls" to do what was right for that man. I also have only told this story to other nurses, not even my then husband, I have told my firefighter son, because as a paramedic, we share our stories. This man should not have died. The ER failed him, and the docs failed him, and I still feel that the nurses failed him because we were all new grads and had never experienced this before. It still makes me sad to think about him, but I use that knowledge I gained from this experience to help other patients to this day."

:crying2:

P_RN, ADN, RN · Apr 23, 2004

Be on time for work. Inconveniencing everyone by being late is not the best way to start out.

I like the SPONGE.

Help others and ask for help when (not if) you need it.

Practice, practice, practice doing things fully every day. Make a list if necessary of all the things you must do a shift. (1)clock in (2) get report.......down to (20+) enter your I & Os and clock out.

J Lynn · Apr 23, 2004

As a soon-to-be new nurse, I greatly appriciate all this advice. I hope to read more.

rosemadder · Apr 24, 2004

Thanks everybody, these were some great tips!!! I agree with each wholeheartedly!

bellehill, RN · Apr 24, 2004

Relax...it is hard to kill a patient unintentionally.

I love the be on time tip, if report starts at 7am, be there with papers in hand and coffee at 7am-not just walking in the door.

When new nurses are stressed I will gladly help you, when I am stressed please ask if you can help me with anything...the answer is probably no but please ask(if not I won't help you).

Nurses spend most of the shift stressed out, don't get offended if our answers are short ocassionally, we don't mean anything by it we are just busy.

Ask, ask, ask...know what you don't know.

Don't ever let a doctor talk down to you.

bellehill, RN · Apr 24, 2004

Relax...it is hard to kill a patient unintentionally.

I love the be on time tip, if report starts at 7am, be there with papers in hand and coffee at 7am-not just walking in the door.

When new nurses are stressed I will gladly help you, when I am stressed please ask if you can help me with anything...the answer is probably no but please ask(if not I won't help you).

Nurses spend most of the shift stressed out, don't get offended if our answers are short ocassionally, we don't mean anything by it we are just busy.

Ask, ask, ask...know what you don't know.

Don't ever let a doctor talk down to you.

Tx-top nurse · Apr 24, 2004

Wow!!!

Thanks guys for all that great info. And good luck to you with your nursing career..:)

Tx-top nurse · Apr 24, 2004

Wow!!!

Thanks guys for all that great info. And good luck to you with your nursing career..:)

**canoehead, BSN, RN** · Apr 25, 2004

I disagree with the person who said to give the Lasix without an order. You can lose your license, seriously. Call someone every five minutes, call your supervisor, insist that they come to the floor to see for themselves how sick your patient is. If no one will give a decent order, call a code if you have to, but get a provider to the bedside. You can deal with the repercussions of being pushy for your patient but not with losing your license.

Having been in similar situations as a supervisor I know that if they are too bullheaded to listen to your concerns there is no way they will back you up for giving a med they already said not to give. Many times I've had patient transferred to ICU so that I would stop "bugging" the doc, and once called a code on a guy that wasn't quite there yet, but he wasn't getting appropriate treatment. But both ended up where they needed to be and no one's license was on the line.

By the way, the sup who you called who didn't come up to the floor and assist you in getting attention for a dying patient is lower than frog slime in my book. If you can get your manager to review that chart and present it to whoever is the medical head it may make some changes. Ask her if you have the option of calling straight to the attending if his minions aren't responding to you-you should have his number available on the floor.

**canoehead, BSN, RN** · Apr 25, 2004

I disagree with the person who said to give the Lasix without an order. You can lose your license, seriously. Call someone every five minutes, call your supervisor, insist that they come to the floor to see for themselves how sick your patient is. If no one will give a decent order, call a code if you have to, but get a provider to the bedside. You can deal with the repercussions of being pushy for your patient but not with losing your license.

Having been in similar situations as a supervisor I know that if they are too bullheaded to listen to your concerns there is no way they will back you up for giving a med they already said not to give. Many times I've had patient transferred to ICU so that I would stop "bugging" the doc, and once called a code on a guy that wasn't quite there yet, but he wasn't getting appropriate treatment. But both ended up where they needed to be and no one's license was on the line.

By the way, the sup who you called who didn't come up to the floor and assist you in getting attention for a dying patient is lower than frog slime in my book. If you can get your manager to review that chart and present it to whoever is the medical head it may make some changes. Ask her if you have the option of calling straight to the attending if his minions aren't responding to you-you should have his number available on the floor.

Hellllllo Nurse, BSN, RN · Apr 25, 2004

Always check the pt's allergies when giving a med you havn't given him before. Do this even if the pt has already been getting this med from other nurses.

There have been a couple of times in my career where there have been pts w/ itching and rashes, and no one knew why, they just kept giving Benedryl.

In one case, the pt had been getting a med that he was allergic to, for three days. In the other case, nurses kept giving Benedryl, Atarax, applying cortisone cream to a new admit. Couldn't figure out what was causing the itchy rash. Her chart said she was allergic to latex- and the pt had a latex foley in.