The Uncertainty of it all

[garciadiego]

I started on a busy Med. Surg floor one month ago, after spending my entire 15 year career working LTC. The busyness of the Med. Surg. floor is blowing my mind, especially given the fact that I will be on my own next week.

One of my problems is that I get freaked out when multiple events are occuring at the same time that I have to take responsibility for- like getting 2 admits, having to discharge someone, having to start an IV, having to get my meds out on time, etc/ etc/, when all this happens at once I start to panic- is there any thing I can do to chill out and think logically about the situation?

It also takes me along time to perform tasks although I'm picking up the pace, but my big uncertainty is giving IV meds and the question of whether to push them or hang them in a bag, and how fast to give the med in the bag. I refer to the drug book for instance, which says give Compazing IV push 5mg over One minute, but the nurses on the floor say put it in 50cc of NS and give over 5 min.- they contradict the book because the nurses have had patients go hypo tensive giving it IV push one minute. So aside from refering to the drug book, what IV meds do you give in a bag and what IV meds would you push at a certain dose and when the dose is higher when would you put it in a Bag of Ns and give it, and how fast?

Thank you.

[Daytonite, BSN, RN]

what you are experiencing is what we all experienced when we were new grads working as hospital nurses for the first time. it is a culture shock! a good part of what is happening is that you need to learn to organize and prioritize. and, that is something that you learn over time and by learning from making a few errors in judgment.

one thing that you have to realize is that freaking out is hurting no one except you. you have to mentally tell yourself to calm down. this is a mental statement that you have to take the time to remember to tell yourself when you start to feel panicy. you can only do one thing at a time. this is where you have to look at priorities. you usually have time leeway on giving meds and ivs so you can put them off for a bit. admissions need to be looked at and assessed asap because you don't know what kind of condition those patients are in and you don't know if there are any stat orders that need to be carried out. discharges are also something that can be put off--those patients are stable and unless they are chomping at the bit to go, they can wait a few minutes while you assess a new admission.

you have to also realize that as a newbie it is going to take you some time to become a master at doing the various hands-on skills you need to do. nursing school only exposed you to them. now, you need to hone in and master them. practice, practice, practice. you will get experience and get better each time you do them.

as for putting iv pushes into piggybacks. . .that is something that many hospitals i worked at was a policy. we pushed nothing except during code blues. everything was mixed in a piggyback and dripped. you might want to take some of your free time and check your hospital's nursing policy on giving iv pushes. it saves the time of standing at the bedside and watching your watch while you are pushing the drug. also, many of these drugs are very irritating to the veins, so mixing them in a small bag of d5w or ns is doing a service to the patient's veins. there is also the threat of a patient having an anaphylactic reaction to a direct iv push. almost all iv medications can be mixed in d5w or ns and dripped. if you ever have a question about a drug, call the pharmacy and ask one of the pharmacists--that's part of their service to the nursing staff.

i want to tell you about this business of starting ivs. when i first started as a hospital nurse it was one of my major problems. if i had one or two ivs that needed to be started during my shift it ruined my whole day. i went to work hoping that the issue wouldn't even come up. after 6 months of struggling with this, one of my supervisors had been suggesting to me that i should take the same iv certification course that the lvns here in california take to learn more about the skill--and it is a skill. i finally did it despite the fact that i felt embarrassed to be an rn sitting in a class with lvns. however, unlike my lvn classmates, i could go back to work and practice what the instructor was teaching us--they couldn't because they were restricted from doing anything until they actually got their certification, but i was already a licensed rn. what a difference this class made for me. i started taking every opportunity that came along to start or re-start ivs. my improvement started showing within 6 months and i was on my way to becoming a real pro at doing ivs. i not only learned about starting ivs but how to maintain and manage the iv drips from this course. i went on years later to become an iv therapist and become nationally certified in iv therapy. iv's are a difficult skill to master and not as easy as some people might want to fool you into thinking it is. it took me years to master this skill and when i hear people toss around their "skill" at it after only a few successful sticks i know it is only their ego talking.

if you haven't been told this already, let me be the first. it takes at least 6 months to even start to feel like you have some control over your new role as a hospital nurse. and, in reality, it will take 2 years or more before you will start to feel really confident in what you are doing. now, you can go back to ltc if you want because that is what you know. however, i also started out in ltc and went to the hospitals. to become a hospital nurse you just have to stick it out and put in the time. it does get better as time goes on. you are merely in a very intensive learning phase right now that we have all had to go through, so just hang in there and keep putting one foot in front of the other and try to stay calm. you will have good days and bad days. as time goes on the good days start to outnumber the bad days.

[garciadiego]

Daytonite,

Your reply was wonderfully helpful, encouraging, and I was beginning to think I would get no reply. I really mean this, your reply answered my questions and has put me somewhat at ease with my situation,

Merry Xmas

[learnN2bnurse]

garciadiego,

I understand what you are going throught, I feel the same way! I just finished my orientation and have had my first two shifts on my own. Thank goodness that the majority of the nurses on the floor where I work are more than willing to be there when you need them.

[RNSuzq1, RN]

Hi Garcia,

You're right, the busyness on a Med/Surg floor will "blow your mind". You mentioned multiple events happening at the same time and sadly, that's just the way it is on these floors. Never fails, I'll be gloved up doing something and get paged to 3 different rooms. Trust me, you'll drive yourself crazy if you try to do everything at once. Best way to handle it is to prioritize, delegate what you can, take care of the most important things first and get to the rest as soon as possible.

If you're busy with a pt when a new admit comes up - have the CNA get the new pt settled while you finish what you're doing. The worst thing you could do is to run from pt to pt leaving unfinished things that you plan on getting back to later - chances are, other things will come up and you'll never get back to them.

We had several Nurses from LTC start on our floor this past year. I thought LTC was as busy as we are, but apparently not. Two of them said the pace was too overwhelming, said we were all crazy for putting up with the work-load and went back to their old jobs. Even if you don't stay in Med/Surg long, it's good experience, so stick it out as long as you can. Good Luck in your new job!!!

[garciadiego]

I want to thank all who responded to my plight, all replies are very helpful. I'm on my own tomorrow and am nervous, but I intend to perservere.

Merry Xmas

[rnmi2004]

One of the things that you don't realize is how much time it takes to think things through when you're new at this. I've been doing med-surg nursing for almost 3 years now, and I can see in my orientees how it slows them down to have to process and prioritize situations. This isn't a bad thing-it is to be expected!

I remember seeing discussions of the multiple choice answers for the NCLEX practice questions--the new grads have to analyze which order to put them in, while the experienced nurses say that they do all of them at once. And that is kind of what it is like--after a while you're processing multiple tasks so simultaneous that it really makes the night flow a lot more smoothly. You'll also be more familiar with the floor & med supply room layout, what the number to the pharmacy is, how to get a hold of the attending or resident, etc.

[WickedRedRN, BSN, RN]

I am glad I saw this, I could have written the original post myself. I just recently switched from LTC to a very busy LTAC and feel I am way over my head. Daytonite, your words are wonderfully comforting, great advise, thank you!

[SarahK73]

I like you made the big jump from a long term care facility to a busy Med-surg unit in the hospital. I thought I was a great nurse and was confident in my 13 years of experience. Nothing really prepared me for the change in acute care. I was terrified because I felt like I was a brand new grad, in fact I wanted everyone to think I was a brand new grad! I realized with a little help that my expectations of myself were much more harsh then those around me.

IV's were my down fall as well, I could not get any of them! I was to the point that I didnt want to even try. My manager at the time gave me the opportunity to go to pre-op in our Short Stay Surgery for a couple of days where they put IV's all day long. Once I quit psyching myself out I got better. The thing about Med-Surg that even the veterns will tell you it is always changing, you will always have new things to learn and no one knows it all!