Tips for nurses in their first year of nursing

AngelsRN · Dec 20, 2005

Okay, as a nurse with over 30 years experience (LPN and RN), I am going to give you guys a bit of advice here.
ASK---if you don't know, don't fake it. The old-timers absolutely do NOT expect you to know everything. They know you are scared poopless. Contrary to popular belief, older nurses do NOT eat their young. Too many bones ;-D. We know that you are the future of nursing, and most likely (hopefully, even) will be the ones taking care of us when we inevitably succumb to life's physical insults.
WindwardOahuRn, aka ICU maniac

Unfortunately, this is not entirely accurate --- some older nurses do eat their young --- it seems to depend on the culture of the hospital and/or unit. It is rare I have found, but I have seen it happen.

medsirgrn · Dec 22, 2005

Thanks for the the words of encouragement which are well stated . Iwill try to adhere to what has been said . thanks.

medsirgrn

medsirgrn · Dec 22, 2005

Thanks for the the words of encouragement which are well stated . Iwill try to adhere to what has been said . thanks .

medsirgrn

medsirgrn · Dec 22, 2005

Hello everyone, this is my first time on this site . I recently passed my boards and I will begin working in January. To be honest I am a bit nervous and I am wondering if everything is going to be ok. These advice are wonderful and resourceful and I hope It will be able to help me to get through the beginning of my nursinmg career and beyond.thanks.

Forever10 · Dec 24, 2005

I have to admit...I am still a bit nervous concerning all the Math (Algebra),Anatomy, Physiology etc., my Prereqs., but I have found a lot of help through this thread and study materials I've come across. I have been out of the "School study mode" since 69 and have raised 8 of 10 children(2 still in the nest-9 and 13), but want to do this with all my heart, so please keep me in your prayeys y'all. I have a small voice recorder, which I have just started using and am beginning to learn my Anatomy basics that way. I found Holes Anatomy online, but would like to ask if there is another I should be checking out, (trying to get a bit of a head-start). My biggest concern upon deciding to become a Nurse was thinking, "What if I go thru all this studying and fail my RN entrance exam...? For now I will keep pluggin and just try and do the best I can. I'm not a spring chicken anymore, but do have the intense drive to not give up! *Correction* I had my dates mixed up, am starting pre-Nursing courses Jan. 18, 2006 at a local Community College and will hopefully begin the RN AAS in Spring 2007. Since reading these threads and hearing all of the intense and great info./advise, I am starting to relax more. I know a lot of you out there have been where I am now, so that helps tremendously. You all are SO NEEDED! Thanks for being there for all of us "beginners"...and God Bless!

I guess the biggest words I personally need to learn for now are... RELAXXX and Breathe!

Peace,

Faith

newrn05 · Dec 27, 2005

I can tell you one thing I think makes a great preceptor. Anything that they feel they need to tell the Nm or the NE they need to tell you. I think hearing it from them is better then hearing it second hand. You are able to ask them direct questions about the issues at hand.

journeeyh · Dec 29, 2005

hello,

i am currently in school to become an lpn. i am terrified :eek: because i have a weak stomach. sputum and feces make me ill. i really enjoy helping people. i am willing to dedicate 110% of my time effort and heart to provide phenomenal patient care. while my long term goal is to become an anesthesiologist

my short term goal is to become an lpn. the first reason is because i think becomig a nurse is an excellent way to learn patient care and bedside manner. the second reason is becasue my current job would never give any sort of tuition assistance for any medical related carrer. i love working in the medical field and nursing is so hands on. will i ever be able to get over my weak stomach? any suggestions, what do i do? please help!!!!!!

journeeyh

Forever10 · Dec 29, 2005

Fear not Dearheart...you will do just fine. From my oint of view this sort of thing takes a bit time. I am not a Nurse yet, (starting my prereqs. in a few wks., but have (nursed) many children thru the years. Now this isn't intended to be funny, but I know after raising 8 (2 to go) and them all getting sick at various times (and usually came down with the same thing at the same time) that I can only share how I reacted both during and after each episode. It's not an easy thing to deal with when the cleaner-upper has a weak stomach...With my first few children...I just joined right in! But over time I sort of got used to it. I've personally learned to just tune that smell out, (It's the odor that really gets ya) by thinking of something more pleasant, till the cleanup was done. I'm sure everyone has their own ways of dealing w/ the nasty stuff, but it's all part of signing the dotted line I guess. You just have to learn to deal w/ it. I'd love to hear how others in the Nursing community have overcome this not so easy part of being a Nurse, who also share in the weak stomach thing.

Peace,

Faith

pugmum · Dec 29, 2005

we recently implemented the sbar tool at our hospital in an effort to help new nurses, or students in making sometimes dreaded phone calls to cranky physicians. if it helps, great :).

i have heard that it comes from other hospitals in the us, and some of you may be familiar with it. our new grads (and some "old" ones) have found it helpful to organize the info you want to present.

this part is the actual worksheet:

sbar report to physician about a critical situation

s situation

i am calling about .

the patient's code status is

the problem i am calling about is ____________________________.

i am afraid the patient is going to arrest.

i have just assessed the patient personally:

vital signs are: blood pressure _____/_____, pulse ______, respiration_____ and temperature ______

i am concerned about the:

blood pressure because it is over 200 or less than 100 or 30 mmhg below usual

pulse because it is over 140 or less than 50

respiration because it is less than 5 or over 40.

temperature because it is less than 96 or over 104.

b background

the patient's mental status is:

alert and oriented to person place and time.

confused and cooperative or non-cooperative

agitated or combative

lethargic but conversant and able to swallow

stuporous and not talking clearly and possibly not able to swallow

comatose. eyes closed. not responding to stimulation.

the skin is:

warm and dry

pale

mottled

diaphoretic

extremities are cold

extremities are warm

the patient is not or is on oxygen.

the patient has been on ________ (l/min) or (%) oxygen for ______ minutes (hours)

the oximeter is reading _______%

the oximeter does not detect a good pulse and is giving erratic readings.

a assessment

this is what i think the problem is:

the problem seems to be cardiac infection neurologic respiratory _____

i am not sure what the problem is but the patient is deteriorating.

the patient seems to be unstable and may get worse, we need to do something.

r recommendation

i suggest or request that you .

transfer the patient to critical care

come to see the patient at this time.

talk to the patient or family about code status.

ask the on-call family practice resident to see the patient now.

ask for a consultant to see the patient now.

are any tests needed:

do you need any tests like cxr, abg, ekg, cbc, or bmp?

others?

if a change in treatment is ordered then ask:

how often do you want vital signs?

how long to you expect this problem will last?

if the patient does not get better when would you want us to call again?

guidelines for communicating with physicians using the sbar process

1. use the following modalities according to physician preference, if known. wait no

longer than five minutes between attempts.

direct page (if known)

physician's call service

during weekdays, the physician's office directly

on weekends and after hours during the week, physician's home phone

cell phone

before assuming that the physician you are attempting to reach is not responding,

utilize all modalities. for emergent situations, use appropriate resident service as

needed to ensure safe patient care.

2. prior to calling the physician, follow these steps:

* have i seen and assessed the patient myself before calling?

* has the situation been discussed with resource nurse or preceptor?

* review the chart for appropriate physician to call.

* know the admitting diagnosis and date of admission.

* have i read the most recent md progress notes and notes from the nurse who

worked the shift ahead of me?

* have available the following when speaking with the physician:

* patient's chart

* list of current medications, allergies, iv fluids, and labs

* most recent vital signs

* reporting lab results: provide the date and time test was done and results of

previous tests for comparison

* code status

3. when calling the physician, follow the sbar process:

(s) situation: what is the situation you are calling about?

* identify self, unit, patient, room number.

* briefly state the problem, what is it, when it happened or started, and how severe.

(b) background: pertinent background information related to the situation could

include the following:

* the admitting diagnosis and date of admission

* list of current medications, allergies, iv fluids, and labs

* most recent vital signs

* lab results: provide the date and time test was done and results of previous tests

for comparison

* other clinical information

* code status

(a) assessment: what is the nurse's assessment of the situation?

® recommendation: what is the nurse's recommendation or what does he/she

want?

examples:

* notification that patient has been admitted

* patient needs to be seen now

* order change

4. document the change in the patient's condition and physician notification.

i found this link on google.

www.ihi.org/.../patientsafety/safetygeneral/tools/sbartechniqueforcommunicationasituationalbriefingmodel.htm

NaomieRN · Dec 30, 2005

Listen to your patients and care for them as if they are your family.

Love never fails

Forever10 · Dec 30, 2005

Amen Sister

weezer123 · Dec 31, 2005

Have you ever thought of Dr.Office? weekends off and holidays off...