University of Colorado Hospital

[nhnurse25]

I recently accepted a position at the main campus of University of Colorado Hospital. I am nervous about going from a 120 bed hospital to a large teaching facility. I will be working a mix of days and nights in med surg / resource pool. Has anyone worked here or provide good advice for a new travel nurse. I am so nervous about my IV skills, I am not the best at them and don't want to appear unqualified. The hospital I was in I also did not get much experience with NG tubes. And it has been 2 months since I have worked due to taking some time off for family. I guess pre job jitters are normal???

[NedRN]

Ideally your concerns would be discussed in the facility interview with the manager. Then you are on record and there are no surprises. Moving forward, telling them about weaknesses upfront when you get there is still a good idea so they can make appropriate assignments and perhaps give you a preceptor who can give you a good inservice.

However, I think you are unduly concerned. I think even I could do an NG tube (I'm an OR nurse) and I doubt that placing one is commonly done on MS even once a week per nurse (a real MS nurse can chime in here). IVs are just a matter of practice. Almost everyone has difficulty once in a while starting one, so there is no shame in having someone else take over. At some point, your skills will improve. There may even be an IV team!

[PacoUSA, BSN, RN]

I dont know if I qualify as a real MS nurse, I'd like to think not as I am gradually moving my way away from MS to strictly cardiac and tele, but I still float to medicine and surgical units every so often. NG tubes are not that common, you may encounter one or two if you are lucky in your entire assignment. NG tubes are likely most common on dedicated GI units. For that matter, I dont even see too many chest tubes and it is one of the areas I feel that I am lacking in. Fortunately, you will always find an RN wiling to help you out that knows the ropes on that unit.

Fortunately as well, I have never been in a position to insert an NG tube, and I would always defer that responsibility to an MD, as I have yet been to a hospital where this is done by RNs. What you will see most common on MS units are things like IV fluids and more than likely heparin gtts, protonix gtts, and wound vacs. Very rarely if ever will you see cardiac drips, those always go to tele units.

As for IVs, practice makes perfect. Find out if U Colorado has IV teams, they will make your life so much easier! I have traveled to 2 hospitals already that have IV teams, coming from a hospital where floor RNs did ALL IVs. I do miss doing them actually, but I dont miss an infiltrated IV stalling my work flow! :)

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[Soliloquy, MSN, APRN, NP]

I'm on a Surgical oncology floor and I've gotten quite a few ng tubes, even had to put them in a few times in my time here. But it's not hard or "scary" and you can always ask for backup.

But I always get the feeling that my experience as an rn and the experience others get is so different. My old med surg floor was considered general medicine and we got cardiac drips and Tele and insulin drips out the wazoo! Then I was told that isn't typical med surg. Now I'm here and I tell people what I get and they say that doesn't fully qualify as med surg. So I'm kind of at a point where I just go with the flow and ask for help prn.

My point: ask for help.

[Michi66]

I'm a fairly new nurse on my second assignment with a med-surg/tele background. The first hospital I worked at was a smaller community hospital and for the most part, had lower acuity patients (damn Observation Unit). First travel assignment was on a very cardiac heavy floor, so did lots of things for the first time, or only did once or twice before (cardiac drips, post caths, post CABG, bedside cardioversion, etc.). Now my second assignment is in a teaching hospital (albeit only like 400 beds, so not huge) on a tele/onc floor. I told the charge nurse at the interview that I had no oncology experience and she said that was ok. That being said, second day involved a patient getting intrathecal chemo... While I still get a couple of chest pain/afib RVR patients, many now are heavy med-surg. Lots of colostomy, drains, neph tubes, NG tubes (not placement as much, as they tend to stay in, just need to make sure it's not clogged!), ports, post-ops, etc.

I guess my point is, you will likely see more diverse diagnosis (especially as a float RN!) and get to practice more skills that are completely new or ones you're not confident in, and it will be SCARY. Like the previous commentator, just keep calm (NEVER let others see that you're stressed! It can be hard though), think about what's going on, and ask lots of questions. The cardiac floor I was on had tons of travel nurses and even though the morale of the perm staff was kind of low and some are intimidating, they were all helpful. At this teaching hospital, there are less travelers (I'm here because all the perm staff are pregnant), but the staff are equally helpful (not to mention it's in CA so there are more resources like Break RN and pregnant RN's on "modified duty."). And everyone once in a while you will hear a perm staff ask a question only you know the answer to because you have a different background or because you JUST went to computer training :). After a month or two it'll get easier, and just after you aren't scared to go to work anymore, it's time to leave!