switched to Med Surg from PP

[sukh :), BSN, DNP, RN, APRN]

Hi,

I am a PP nurse for the last 6 years recently switched to Med/Surg unit (because it was dream ). I am going through 3rd week of orientation. Taking four patients with one admission thus going to five with help from my preceptor. I feel so behind in everything, my preceptor says i need to improve my time management skills. I go on pt rounds with Doctors as well as Case Managers. but I always forgot to give information about many things during report to next shift nurse, my preceptor then starts saying it all ( i feel so embarrassed as if i did not know my pt). there are so many new terms. The other day i forgot that what kind of bacterial infection was found in my patients UC. At the time of report, my preceptor has all information about the test results and plan, and even though i have been taking care of them all day running from room to room , i have no idea of that.

I feel so incompetent and i feel like they must be thinking i am dumb

Please advice how I can manage my time and get better in reporting and a competent Med-surg Nurse.

All comments are welcome.

Thanks in advance.

[NGYSUN, BSN, MSN, RN]

Hello there!

It will take you awhile before you master the art of time management on a medsurg floor.

To remember stuff, I always had a small notepad in ma pocket, and a pen or pencil...helped me write stuff, to remember.

For report, I used my brain sheet , you can search for brain sheets here on AN, there was a post looooonngg ago on brain sheets.

Also, don't wait for the time for an assignment to reach, you can begin your physical assessment the moment you go in to greet your patient. Do they have a urinary catheter, I.v fluids - which arm? Just to mention a few.

Oh, and if they're on oxygen, BE SURE the tubing is WELL connected. I hAd a terrible experience on disconnected oxygen tubing.

Lastly, be nice to your CNA's, from my experience they have saved my behind a lot. I love and respect them...

Try and cheer up, it will get better and you will be able to tell and teach other new nurses in medsurg the tricks that got you by...

All the best. [emoji106]🏻

[sukh :), BSN, DNP, RN, APRN]

Thanks a lot, NGYSUN, for suggestions and encouragement. you are right, i should carry a little sheet with me to write imp things on it. I am also going to look for the brain sheet for help.

Thanks a bunch again

[Double Dunker]

I carry an orange ink pen in my pocket, so that when new labs come in or there's a change in status, I write it straight onto my brains and it stands out so I remember to give the info to the next shift.

[ClaraRedheart, BSN, RN]

It's really a whole new world. You are a nurse, you've been trained, but.. unless you started in med-surg or somewhere with an equivocal patient load and plethora of experience, there is no way to keep up the knowledge that you paid for. That being said, if you ARE a nurse, and went through the same training the rest of us went through, you CAN do it.

I've worked with a few med-surg nurses that have worked more stressful units for years, and for personal or family reasons have needed to step-down on the stress level. They've all found friends in postpartum units that have found jobs for them. My former supervisor used to say: "Postpartem is where nurses go to die". In my opinion, post partum jobs should be reserved for nurses who have done their time on other units and who are nearing retirement. Yes. You can and WILL lose your nursing skills... including time-management.. Six years is a LONG time, so you really DO have a lot of catching up to do.

You need to train from a NEW nurse standpoint on their floor. Their is NO way that they should expect you to come from PP to a competent nurse with just ON the floor training. You really need the help of something like the Versant program.. which is AWESOME for a new nurse, but would be even better for one expanding her field. Versant provides an overview of your expected patient population and the diseases and interventions that you can expect. It melds classroom with on the floor training with vetted mentors. My hospital does it only for new nurses.

I do not understand WHY a hiring manager in their right mind would hire a PP nurse for a med-surg job with only a few weeks floor training. You are likely in a poorly ran unit if someone made that judgement decision. Honestly, you might be poorly suited to med-surg from the description. If you want to do it right, try to find someone with a Versant program or equivalent who will take you. If your work unit is willing to take a post-partum nurse and give you sub-par training, you can expect sub-par management and poor unit dynamics as a result.

[NurseStelri]

Some things that I found helped me a ton when I started in MedSurg:

1. I created my own brain sheet with things that I personally wound forget when getting/giving report. For example, we have to chart q2h on patient's with restraints so I have a spot on the bottom of my brain for restraints even though I do not have a restraint pt everyday, it always reminds me to chart when I do. I also have a column for activity and voiding because I always forget to ask "Can they walk" or "How do they void" unless i have this sheet lol. But this is just how my brain works so find what you always seem to forget to ask at report or tell at report and then create your brain that way. I know my brain sheet doesn't make sense to most people but it really leads me when I give report.

2. Whenever I draw blood, urine, etc I always draw a checkbox on my brain with the lab draw so I know to keep checking for the results, once I get the results and write them down I can check the box!

3. ALWAYS CARRY A HI-LIGHTER! lol I always hi-light things on my brain that I A) Have to do like wound care B) Need to assess

3. When I see the oncoming shift start arriving I start preparing myself for giving report. "Did I empty all the drains? Did I double check with the MD about this confusing order? What questions will they ask me, because I have time to look back in the chart now and get prepared". ((Although, yes some days are busy and I can't be fully prepared but usually my noc shift is understanding when I hand off after a trainwreck of a day lol))

4. Read the MD's note. I know a lot of people say there is not enough time for this but that is the first place I go when looking up my patient. They tell us the plan and rationales so I have a clearer picture of what I am doing with that patient vs just completing tasks. Just by reading these notes I am able to give a much better report because even if I miss something about the pt, I am able to give them the overall plan and report which is always appreciated.

You'll be okay, it gets better and you are most definitely NOT incompetent. I started in Med Surg with about 10 other new grads and I would say about 5 or 6 of them had preceptors similar to yours. Once off orientation they all said it was 10x better because they were able to find out what worked best for them and they didn't have a preceptor that was making them feel inadequate. Just the other day a new-hire gave me report and her preceptor added in clarifications as necessary however if the preceptor wasn't there I could have easily gotten the info from the new-hire-- I think the preceptor jumped in to start give report out of habit lol

[sukh :), BSN, DNP, RN, APRN]

Some things that I found helped me a ton when I started in MedSurg:

1. I created my own brain sheet with things that I personally wound forget when getting/giving report. For example, we have to chart q2h on patient's with restraints so I have a spot on the bottom of my brain for restraints even though I do not have a restraint pt everyday, it always reminds me to chart when I do. I also have a column for activity and voiding because I always forget to ask "Can they walk" or "How do they void" unless i have this sheet lol. But this is just how my brain works so find what you always seem to forget to ask at report or tell at report and then create your brain that way. I know my brain sheet doesn't make sense to most people but it really leads me when I give report.

2. Whenever I draw blood, urine, etc I always draw a checkbox on my brain with the lab draw so I know to keep checking for the results, once I get the results and write them down I can check the box!

3. ALWAYS CARRY A HI-LIGHTER! lol I always hi-light things on my brain that I A) Have to do like wound care B) Need to assess

3. When I see the oncoming shift start arriving I start preparing myself for giving report. "Did I empty all the drains? Did I double check with the MD about this confusing order? What questions will they ask me, because I have time to look back in the chart now and get prepared". ((Although, yes some days are busy and I can't be fully prepared but usually my noc shift is understanding when I hand off after a trainwreck of a day lol))

4. Read the MD's note. I know a lot of people say there is not enough time for this but that is the first place I go when looking up my patient. They tell us the plan and rationales so I have a clearer picture of what I am doing with that patient vs just completing tasks. Just by reading these notes I am able to give a much better report because even if I miss something about the pt, I am able to give them the overall plan and report which is always appreciated.

You'll be okay, it gets better and you are most definitely NOT incompetent. I started in Med Surg with about 10 other new grads and I would say about 5 or 6 of them had preceptors similar to yours. Once off orientation they all said it was 10x better because they were able to find out what worked best for them and they didn't have a preceptor that was making them feel inadequate. Just the other day a new-hire gave me report and her preceptor added in clarifications as necessary however if the preceptor wasn't there I could have easily gotten the info from the new-hire-- I think the preceptor jumped in to start give report out of habit lol

Thankyou í ½í¹so much for the encouragement, NurseStelri. I think I am getting better now I am taking the full load now and the tips about the brain sheet and highlighter are very useful I am working on making my own brain sheet. I always try to read the doctor's note and it definitely is very informative. Can I please request you to send me your brain sheet so that I can compare mine or add few things from yours( you definitely must be having much refined brain sheet than mine hence it will be a guide for me í ½í¸Š).i will be very grateful.