Tips for nurses in their first year of nursing

mo_07 · Jul 7, 2008

Ever have an "I wish I was told this" moment? Well, we all do as nurses regarding school. Here are some things I wish they told me nursing school (and some I wish they had emphasized more)----and what I told another new BSN nurse in a different thread (and it would be the same advice I would give any new nurse/grad):
You have achieved a great thing, graduating and earning your degree (BSN, ADN , LPN or Diploma). Now, the REAL learning begins......

Don't ever pretend to know what you don't. Be a sponge---watch and listen to what is going on around you. Take mental notes. Find mentors and emulate their good habits. Take note of the bad habits and avoid those.

Listen to your patients; they know their bodies better than you do.

Have integrity----be honest with yourself and others.

Stay out of the gossip game/circle. It goes nowhere and brings down morale, including your own.

Be on time! EVERYtime. When you are late, so am I. And I don't like to be late!

Stay organized as possible. Keep up on your charting and tasks as they come up. Dont' save it all for "later"---there may not be time, "later".

Do it right the first time, even if there IS "no time". Believe me, there is no time to "Do it over", either.

Plan for the worst; hope for the best.

Be someone they can rely on---and rely on yourself!

Take good care of yourself; eat well, exercise. It's the only body you got and you are gonna need it. Nurture the self. Nurses have a tendency to martyr themselves and neglect their own needs. Don't be one of them; it's a fast superhighway to burn-out.

Nourish the mind. Plan on spending a LOT of time investing in your continuing education as a nurse. The world of nursing/medicine is changing faster everyday. You are going to have to make a conscious and concerted effort to "stay abreast". It's more work than you imagine right now.....plan on it.

Learn assertiveness if you have not already. Lots of good books and conferences/seminars exist. Learn early-on you no are NO ONE's doormat. Also, know there is a difference between "assertion" and "aggression".

Work hard, yes, but don't forget to PLAY hard too! Have hobbies you enjoy. Your life is NOT your work, and while being a nurse is part of who you are, it need not *define* you.

Believe in your self and good instincts. Sometimes, "instinct" is what lets us know something is amiss or wrong with our patients. Never ignore that gut instinct. It's very often right! BELIEVE IN YOURSELF!!!!!

After 8 years in nursing, these things are things I have learned the "hard way"; hopefully you don't have to.

Warm, hearty congratulations to you and all new grads here. I wish you all good things in your new careers.

I have one question and it seems that no one can help me find the answer. Do you think you could help?

momelly05 · Jul 7, 2008

I'm a new grad and getting ready to start work as an RN. Any tips from those of you who have been doing this a while on how to be assertive (I hate confrontation)!

maddysmith · Jul 12, 2008

the first year on the job in nursing.

1.ask about first-year nurse turnover rates.

2.find out about orientation and preceptor programs.

3.inquire about support

4.observe the unit

5.consider working on a specialty unit first

6.get your feet wet

"in my opinion, 90 percent of the things in the job are learned not in nursing school but in the job itself,"

maddysmith

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smk1, LPN · Jul 15, 2008

Don't be afraid to say you don't know something. I told my manager how thankful I was to have internet access at work, because their have been quite a few times where I receive a patient who is having a procedure that I know nothing about and need to read a quick excerpt to see where I need to focus my attention, or how to explain something to the patient if they have questions.

xtendedmind · Jul 17, 2008

Cheerfuldoer, I can't thank you enough for sharing this with us (me).

I am still taking pre-requisites but have thought about how to handle such things as they arise. You have been a great big help.

xtendedmind

ena1978 · Jul 18, 2008

I graduated in June and I have been working for 3 weeks in the med-surg unit. I just want to find out from anyone that can help as to how long did it take you to prioritize your patients needs and how to succeed in time management? My preceptor says im doing good but need to improve in both those catagories. Which I believe is still normal for me since I have only been working for 3 weeks. I just feel like I need to be in 5 different places at one time. It drives me up the wall. How can I work in improving this? I try to start my day a little different each day but im still struggling. HELP!!!!!!!! :confused:

white_tigress_247 · Jul 21, 2008

Bring a few quick reference guides along with you - preferably pocket sized... and be aware of where your work place stores any other books or education materials in case you have to refresh your mind or look up info you may not know. AND most importantly, don't be discouraged if you come across something you are not familiar with, or something that you cannot remember exactly. The stress of trying to remember everything that needs to be done and the fast pace of the job tends to shock our minds a bit. As you become more confident and comfortable - you'll become a natural.

Indy, LPN, LVN · Jul 22, 2008

It seems every so often I think of something else. :-)

Organize your patient's room by what they will be doing. For example, put the IV pump on the side of the bed .... so that either it's on the same side as the IV insertion point, or the side of the bed closest to the bathroom, or both.

If you have a patient who for any reason is going to get up a lot for the commode, a bedside commode is good. Here's what you do. Put it at the foot of the bed, same side as the IV pole, right angles to the side of the bed, facing the head of the bed. (I know it sounds complicated but it's not.) So the pt can get legs over side, stand up, turn 90 degrees facing IV pole, and sit down. Very easy transfer and fairly necessary for anyone with a bowel prep, lotta lasix no foley, etc. If they can poop easily without falling you'll be happier. Get 'em baby wipes to begin with for the poopy patients and avoid rashy, blistered bottoms later. Of course all this mostly just works for oriented people. Non-oriented people you're either turning, picking up off the floor or chasing around.

Two things I heard lately but have not done: one, if your diabetic patient is NPO and lost an IV site right about when his/her blood sugar plummeted, you can stick the D50 right up his/her rectum if it's a difficult IV stick. Of course the fun is that you gotta let the physician know what you did and why. Also if you lost the little white connecty piece that comes with a salem sump NG tube, and gotta have one now, get EMT scissors and a 60cc cath tip syringe, cut the tip off and use that. You could also use the tip cover for the 60cc cath tip syringe, cut the end off that. I am really not sure which exact item the nurse who told me this was referring to. And I haven't done either of these things.

Pancake syrup, not the sugar free kind, works in place of molasses, should you have the need to mix up a milk and molasses enema. And if your microwave is short, a short respiratory suction container (looks like plastic disposable bucket) is usually short enough to go in a microwave and hasn't melted on me yet. Remember the EMT scissors? You'll need 'em to cut top off a coke bottle for the funnel. Retention enema bags don't come with a funnel. Nor will most people tell you how to cook up funky stuff like that to go up someone's bum. :-) Oh, and yes it is entirely possible that the tip end of that thing is supposed to be that big. I don't know what people think who manufacture these things.

Don't go anywhere without scissors, tape, hemostats, etc. Hemostats make a good quickie tubing clamp when yours has wandered off.

Oh, and if you have too many tubes or lines up the top end of the bed, and keep getting 'em stuck in the bedrails when turning the pt, try this. Get a tongue depressor and a 1/2 inch thick wad of 2x2's, and your tape. Put gauze wad on bedrail about halfway in the middle of its length, on top of the bedrail. Put tongue depressor on top of that so that it's sticking up on the top end and lying against the bedrail on bottom end. Tape this thing to the bedrail. Use new "hook"-like item to keep tubes and lines from sliding off the bedrail and getting stuck. This is from a picture of a patient who was in Duke University ICU with enough lines and crap to tie down an elephant, and I spotted the things on the bedrails. They work.

Need to have a bed that smells good but not supposed to put powder on your elderly patient's delicate areas? (our managers having a fit about that lately.) Powder the bed, put the bottom sheet on. Or put the powder under the drawsheet. Nice smell, no chafe. And if you're moderate with the powder, no respiratory effect either.

Asthmatic nurses (and patients) don't like the hospital sprays for odors. I remember going home once with a head full of the stuff on my first really bad GI bleed and having a really bad day afterwards. There are automotive fruity smelly spray things that work nice, one squirt makes a 6 bed unit smell good all day long. They may be worth a try. Also keeping vicks vaporub or a little jar of wintergreen oil is a good alternative.

squee-gee · Jul 22, 2008

Wow... I just spent the last 2 hours reading every page of this thread and c&p-ing every helpful tip. I now have 14 pages of invaluable information - just what I need when I start orientation as a new grad RN on August 4th. A big hug to everyone who put in their two cents. I know the real world of nursing isn't going to be like nursing school (which is ridiculous - why can't they just teach us what we really need to know, for heaven's sake?:icon_roll), so getting the lowdown before starting on the unit will be a real help. Thank you, thank you, thank you!:flowersfo I'm sure I will be checking back often to see what new pearls of wisdom have been posted.

PICURN74, ASN, RN · Jul 23, 2008

lots of great information for both new and experienced nurses. The thing that helped me when I started was finding a friend at work, not a mentor or preceptor although the same person can serve more than one role. Having someone to talk about the good the bad and the ugly can make all the difference in a shift. Even if it is someone who can chat for 2 minutes in the med room.

rhondaa83 · Jul 26, 2008

Study, Study, Study Rhonda

rhondaa83 · Jul 26, 2008

study study study. If you study your butt off, you would not be asking that question. sorry Rhonda