Two Weeks to Go

[marshmallownurse, ASN, RN]

..Before I start a new chapter in my nursing career. I've accepted a Neurosurgical and Neurotrauma ICU position in a massive teaching hospital. Despite my background in progressive care, I know I will be in a completely new world where my experience will probably count for nothing, so I'm looking to the wonderful members of allnurses for some guidance on how to prepare and how to approach this new position.

My biggest worries are:

1. I have been out of school for years. I don't even know how to assess my own knowledge of pathophysiology, and neurology was one of my weakest subjects to begin with. Joanne Hickey's Clinical Practice of Neurological and Neurosurgical Nursing is on its way via Amazon. I don't think I'll be able to adequately study its contents in two weeks, but I thought it might be a good place to start. Am I right, or is this a pointless endeavor? I feel like I need to get an Assessment book while I'm at it, but I don't know if it will be a waste of money.

2. I haven't precepted under someone in a long time, at least not in a position where I need to learn a different way of nursing altogether. I know I'll need to reshape my thinking while relearning disease processes in depths that I was never required to study to function in my job on the floor. What pitfalls should I watch out for? When you precept someone, what are your expectations? How do I maximize the benefits of preceptorship in order to prepare for my future role? Would it be appropriate to ask my preceptor to teach me like I'm a new grad? Because I certainly feel like one right now.

I know I'm gonna have to overcome my own habits and instincts, but I'm so excited! I'll be dealing with fresh injuries and surgeries.. These are situations I haven't dealt with, nor had to study, since nursing school. I don't remember the nuances of the sick and injured brain, but I do remember that there are lots of them. That's kind of intimidating and scary. The rules will be different. It will probably be one of the greatest challenges of my nursing career, and I cannot wait to start.

I would really appreciate any feedback anyone can provide. Thank you in advance!

[Ruby Vee, BSN]

Studying is always a good idea. Stick with the one book for now, and then when you start your new job, ask if there is a book that the unit recommends. Some of the larger hospitals have a myriad of study materials they expect you to read and be responsible for, so it's possible that you might not need another book.

I expect my orientees to study at home; very few of them actually take that seriously at first. So you're ahead of the game there. Probably you'll be working with more than one preceptor. Just remember that there's more than one way to do something correctly, and learn the way that each preceptor wants you to do things. As an experienced nurse, you're in a position to decide which of those ways works best for you.

You aren't a new grad, so don't expect to be treated like one. You already know how to do an assessment, although you're going to need to learn neuro assessments in greater depth. You already know how to talk to families and physicians, although you may need to learn how to prioritize the neuro assessment to convey it to the physician. Watch your preceptors to see how they do it. You already know how to do patient teaching, give medications and interpret lab values. Although you will have to learn new medications and some lab values, even a basic ABG, have different emphasis in the neuro patient.

I learn something from every orientee that I precept, and chances are you have something that you can teach your preceptors as well. Don't be afraid to lead by example, but be careful about trying to actually teach them something unless they ask.

This new job will build on what you already know, both from school in the past and from your current practice as a nurse. You're not starting over from scratch! Good luck. It sounds like an exciting opportunity!

[marshmallownurse, ASN, RN]

Studying is always a good idea. Stick with the one book for now, and then when you start your new job, ask if there is a book that the unit recommends. Some of the larger hospitals have a myriad of study materials they expect you to read and be responsible for, so it's possible that you might not need another book.

I expect my orientees to study at home; very few of them actually take that seriously at first. So you're ahead of the game there. Probably you'll be working with more than one preceptor. Just remember that there's more than one way to do something correctly, and learn the way that each preceptor wants you to do things. As an experienced nurse, you're in a position to decide which of those ways works best for you.

You aren't a new grad, so don't expect to be treated like one. You already know how to do an assessment, although you're going to need to learn neuro assessments in greater depth. You already know how to talk to families and physicians, although you may need to learn how to prioritize the neuro assessment to convey it to the physician. Watch your preceptors to see how they do it. You already know how to do patient teaching, give medications and interpret lab values. Although you will have to learn new medications and some lab values, even a basic ABG, have different emphasis in the neuro patient.

I learn something from every orientee that I precept, and chances are you have something that you can teach your preceptors as well. Don't be afraid to lead by example, but be careful about trying to actually teach them something unless they ask.

This new job will build on what you already know, both from school in the past and from your current practice as a nurse. You're not starting over from scratch! Good luck. It sounds like an exciting opportunity!

Oh my gosh, I could've sworn I posted a long thank-you response to this a while back, but it seems I might have imagined that. So sorry, Ruby, that was rude of me. Thank you so much for responding.

I've had a chance to spend some time in the hospital I will be working at and, I have to say, I am a little intimidated. I have always worked community hospitals, which I see now has limited my exposure to a lot of things. Still, this new hospital will be putting me through a transition program, and I am very excited to actually get started. I specially appreciate the advice about watching preceptors and not teaching them. I remember how easy it was to spout "how we did it over there.." comments when I precepted in the past. Oh how I'm cringing at the memory now, lol! Thank you for the reminder.

I'll also make sure I really study at home. Man, this is going to be quite the nursing adventure.