5 things you wish you knew as a new nurse

RNGriffin · Sep 27, 2012

I wish I knew that management makes the job hell, nurses are more arrogant than the physicians I trained, the pay would be less than the labor, families would be worst than the patient themselves...Oh gawd how I love thee!

DizzyLizzyNurse · Sep 27, 2012

1. You can learn something from everyone...even if it's a negative experience.

2. Sometimes you won't like your patient or their families....and that's ok! Just hide it and do your job.

3. A lot of what you graduate thinking is *important*...isn't. You won't learn what's really important and what can wait until you've been a nurse for a while.

4. Take your lunch...and for goodness sake pee if you have to pee!! If a patient told you they had to go to the BR but you seemed busy and they didn't want to bother you you'd tell them that it's not a big deal...only take a couple minutes right? Take 2 minutes and pee!

5. Take your vacations and days off and enjoy them! You don't have to pick up OT unless you want to. Don't let anyone guilt trip you into coming into work on your days off if you don't want to. That's a quick ticket to burning out! Do fun things on your days off!

brownbook · Sep 27, 2012

1). There is not one right way to do things. If you ask 10 nurses for a spaghetti recipe you will get 12 answers, if you ask 10 nurses "how do you do (fill in the blank) you will get 12 answers. You can do it the right way but also do it your way, do what works for you.

2) Use your nursing judgement. The book, computer, even the Dr. orders, whatever information you are using often give exact numbers, "Wait 5 minutes between doses and repeat." If your patient is awake, alert, oriented, on monitors, and complaining of pain you do not look at the clock and count off 5 minutes between opiate doses while the patient is moaning and yelling.

3) It is honestly really really very hard for a nurse to kill a patient with one dose or one pill of any medication or any procedure.

4) Except in rare occasions, really really rare occasions, the patient needs are not so urgent that you cannot stop to look up a drug or confirm a dose or confirm the order or check with a trusted co-worker before it is given.

5) The most brilliant nurse ever born does not, cannot, know everything. You will never know all the medications, all the side effects, everything about the equipment. You must be, should be, saying "I don't know" many times during your career. (Adding, "but I will find out" is nice).

RNGriffin · Sep 27, 2012

I know before I gave all of the things I wish I would have known in regards to on the job.

Realistically..

1. Know yourself and what your values are. This would have saved me ,and I am sure a ton of other new nurse graduates & students a lot of heartache and headaches.

2. Do not limit your experiences to one particular area or even facility. Grow through experiences! You have to dibble & dabble throughout the nursing journey to find the best fit for yourself.

3. Take time for yourself. We all thought we were saving the world when we were admitted into nursing school. I can now say, if I would have taken the time for myself I would have not only not lost valuable vacation time accrued, but I would have remained the person I was prior to beginning nursing.

4. Always challenge yourself and when you feel the need challenge others. The beautiful thing about medicine is nothing is concrete! You have so much knowledge to contribute as a new nurse & even more as human being.

5. Listen to those of us with grayed hair. A lot of new nurses think...oh she/he is 30+ and has been out of school for far too long what do you know. You improve upon yourself by growing from foundations. My seasoned nurses knew a lot more about holistic care than I did with all of my technological training. The most valuable thing you will do as a nurse is care for a person's spiritual and emotional being...Regardless if the patient is in a debilitating state of acutely ill..To go on content w/ themselves is far more than any procedure you will provide.

joanna73, BSN, RN · Sep 27, 2012

The number one thing I wish I knew is that you aren't prepared for your job as a nurse, not until you've actually worked somewhere for 6 months to a year. School and taking charge of your own patient load is very different.

DizzyLizzyNurse · Sep 28, 2012

3) It is honestly really really very hard for a nurse to kill a patient with one dose or one pill of any medication or any procedure.

This.

FurBabyMom, MSN, RN · Sep 28, 2012

1. TRUST YOUR GUT. You may not (will not) know everything. BUT, even so, many times you will spend 8-12-16 hours with a specific patient, and you will probably know that patient better than any doctor, PA or NP will (you may have 5, 6, 7, 8 - whatever your unit will allow). They have many more. And they spend 15-30 minutes with several of their patients on your unit. If you feel like you should get a second nurse (and no, not the other new grad you're besties with, but your charge or an experienced nurse) to look at the situation, or call for rapid response, you probably should. It may seem annoying to have to rapid response a patient, but it's easier to explain why you called for rapid response for a patient over something that may not warrant that much intervention than explaining why you failed to act.

2. ASK QUESTIONS. It's better for you to ask questions over something you're moderately sure of than to explain why you didn't ask your resources later. This can save you in a big time way.

3. ASK FOR HELP. You know, like when you are maybe kind of overwhelmed, before you are derailing because you need help and are overwhelmed. Some units give the new nurses just off orientation the "easy" assignments. You cannot expect that, and even if your unit does it, it will end. On the last med-surg unit I worked on, we had RNs and LPNs. I was a newer RN, but there are things I can do that the LPNs cannot. I would either get those more complicated patients or be expected to oversee those patients and will be legally responsible for your assignment and theirs.

4. DOCUMENT. Document when you page docs, when/if they call back and what their response is/was. Often it's something like 'new orders received, read back and verified, see CPOE orders', or 'MD (name) notified regarding XYZ. No orders obtained, MD (name) requesting to be updated with further changes'. (Same for PAs, NPs etc - modify it for the person you are speaking to). Sometimes, you will be that poor soul that picks up the phone with critical labs etc - and as an RN I was expected to take that call, document the notification values per policy and inform the primary nurse and page the physician or PA/NP. For example, cause this is one I remember, a K+ of 2.5 I would notify the charge too, and probably put the patient on telemetry anticipating that the MD will order a K+ rider, telemetry and repeat labs after the K+ is given. If we didn't have tele packs open I would put the patient on a travel monitor (our travel monitors picked up on our tele monitoring screens). Keep track of policy too - in our facility unless the policy was such that we had to attempt to notify the physician twice (once, wait 15 minutes, call again, wait 15 minutes) and then we would page for a rapid response for orders.

5. When calling docs, you should have your ducks in a row. Have your recent vitals, MAR / general orders, assessment data readily accessible. And know why you are calling. Have an idea what your would expect. Are the patient's electrolytes whacky? White blood cell count high? Hgb and Hct low? Is this a patient that need IV meds for cardiac issues? Or IV meds for high blood pressure? Status changes (decreased LOC, etc)? Is it a patient's behavior, if so what is the behavior? Sometimes, though, the response you will have is and should be 'I think it would benefit the patient for you to come see the patient.' That's okay too.

6. It's good to be hard on yourself, but don't be crazy hard on yourself. Others are right - you will have amazing days and others you will feel stuck on stupid, helpless and like you have not done anything right. Some patients and families are good for that. Some docs are difficult to talk to. Some times things don't work out the way we'd like.

JMBnurse · Sep 28, 2012

I wish I had known from day one how important time management is. I had to learn the hard way. Learn how to do everything quickly. You will never survive on a medical floor in the hospital or LTC if you can't function quickly and efficiently. When I started out, I wanted to be perfect at everything and take my time and do it right, just how they taught me in school. Wrong! I struggled my first year with this. Get it done fast. I'm not advising anyone to be careless and rush and you won't be able to do this right away, but learn how to shave time from your tasks.

I was never rude to Physicians. I always tried to be respectful, but every now and then you will run into one who will try to challenge you. If you are confident and stand your ground, they will usually back down and never cross you again.

I wish I had spent less time my first few years worrying about losing my license. Please don't worry about losing your license unless you are using or stealing drugs and even then you will probably just have it suspended until you get help.

Always show the staff you work with, especially CNA's, that you will never ask them to do anything that you are not willing to do yourself. They will be right there for you whenever you need them if you treat them with respect and as part of the team.

A supervisor once told a bunch of us new nurses, at the time, always take an extra day or two off every couple of months or so. Don't let too much time pass without taking a day. It will ward off burn-out.

Definitely grow and move on to bigger challenges in new positions, but try not to jump into new jobs every 6 mos. It looks bad on your resume. Try to stick it out for at least a year. I believe this is especially important the first year as a new nurse.

RehabRNjc · Sep 28, 2012

1. RN does not mean "smarter than 30 year LPN"

2. Doing something for 30 years doesn't necessarily mean your good at it, RN or LPN, choose mentors carefully, but everyone is right sometimes so don't be too hasty to ignore other nurse's advice.

3. "None of us is a good as all of us" (Ray Crock)

4. Regional Directors don't always wear name badges :facepalm: ; don't lip off to anyone.

5. You don't (and won't) know everything, so know how to find out, know your resources.

Good Luck!

Nascar nurse, ASN, RN · Sep 28, 2012

4. Regional Directors don't always wear name badges ; don't lip off to anyone.

Yikes! That one made me chuckle.

Do-over, ASN, RN · Sep 28, 2012

- There is always time to pee.

- Related to the point above, if you somehow don't feel the urge to pee for 10 hours and when you do it is dark orange, you need to drink more water. Remember, there is always time to pee.

- When in doubt, or when frustrated and feeling overwhelmed, round on your patients. Everyone breathing adequately? Good.

- If you are (somehow, miraculously) all caught up, or at least not terribly busy - answer the call lights/address the beeping pumps/check on the alarming bi-pap. Even if it is not your patient.

- You may not feel very comfortable for at least the first year. Its OK, we've all been there.

Do-over, ASN, RN · Sep 28, 2012

4. Regional Directors don't always wear name badges ; don't lip off to anyone.

And, your boss won't necessarily announce when his or her family member is on the unit...