What you wished you had known before you started your first job?

[AndreaBallard]

I was just wondering if any of you would like to share with us nursing students what you didn't learn or get taught in the nursing program that would have helped you if you had known that information on your first day/week/month of your first job as an RN? Feel free to be candid. Thank you!

[IHeartDukeCTICU]

SMAT-standardized medication administration times... can vary from hospital to hospital but knowing the usual medication administration times.

And... how to put on a patient gown with tons of lines in... haha

[jsroo]

Well, my first job was in LTC-rehab and I was so excited about it....at first!! I wish I had known how much I was going to hate 2nd shift, I wish I had known how mean some docs can be, I wish I had known how lazy some of my coworkers were, and finally I wish I had known the 2 weeks of training I received would never be enough!!! I worked there for almost 4 months before quitting. I'm thankful everyday that I no longer work for such a crappy place!!

[Arievilo]

-When to contact the doctor about your patient - I discovered its better to **** off the doctor than not contact them when you need to clarify something (orders, plan for the patient, ect.) about your patient. Better safe than sorry...you and your patient will sure be happy you did. Very often if a doctor makes a mistake and the nurse follows through with the order...the nurse is also at fault...don't put yourself in that position. You would be surprised how many mistakes are made on a daily basis.

-Organization of your day - this took more time to get down...several months of practice of poorly organized shifts before you get something that works for you. Every hospital is different, every unit is different, every day is different. Its all about your ability to adapt to your patients. A good rule of thumb I go by: see your easy patients before your more difficult patients. Usually those easy patients will only take maybe 5 minutes to look them over and pass meds. Its easy to get caught up with a heavy patient for a long time and neglect your other patients if you don't see them first.

-Time management - again...this comes with time. I remember my first few days off orientation running around the unit desperately trying to get stuff done. Learn how to prioritize. Say...passing essential meds and admitting your new patient is more important than a dressing change or a bed bath that can be done anytime.

-Signs when your patient is heading south - ABCs...Airway, breathing, and circulation. In that order. If you got these, you are usually okay for the time being. Its the more subtle clues that are harder to see. This is still something I struggle with...because you dont have coding patients everyday...at least on my unit.

-How to talk to doctors - they are normal people just like you. Its easy for a new grad to be intimidated at first. I know I was. Remember, you are your patient's advocate...its about them...not you. This goes with the first point...when to contact them.

-How to utilize the resources available to you - other nurses, PT, OT, physicians, pharmacy, lab, mid levels, social workers, care coordinators/case managers, CNAs...they are all essential to your day with your patient. Its important to understand their role in patient care, when to find them, and how you can utilize their expertise.

- Understand that very often the patient looks to you for information. Doctors come in and the patients pretty much nod their heads and smile. They they often turn around and ask you what the heck is going on (or you can easily tell they are clueless). Know what is going on with your patient, the plan, the medication they are on, treatments, procedures they are scheduled for, etc. Be sure to explain it in as simple terms as possible - patients don't get medical mumbo jumbo. Patient education is probably one of the most important aspects of being a nurse.

I'm only 6 months out of school, and these were things I found most important. I am still learning everyday I am on the unit. These are things you don't normally get much exposure to in nursing school. Good Luck to you!

[BackfromRetirement]

How to anticipate what a MD was going to ask when I called them. Be sure you know the pt's diagnosis, age, allergies, current vital signs and Sats.

Also, if you are in LTC make sure you know if the on-call MD should be contacted after 9 pm for infected UA's!

[BackfromRetirement]

Oh yeah, CODE status, cant forget that!

[Davey Do]

"Learn how to prioritize."

EVERYTHING else Arivelo advised was excellent, also.

However, it would seem that the nurses who have never learned this tidbit of information years after graduating continue to run around like the proverbial headless chickens. They have been referred to as "ones who don't have a clue to what is important".

I could also add, "Put principles above personalities."

GOOD question, AndreaBallard! Continue to be an enquiring mind.

The best to you.

[algebra_demystified]

Don't abuse the trust that people give you.

[wound warrier]

Plan for loop-holes in your day, they are always needed. Also, things at work will never go the way you think they should and you will never get paid what you think you should, so just accept it and be happy!!

[CNL2B]

Nobody, including the patient, really appreciates what you are doing for them. It's just expected these days. That was a rude awakening for me when I got out of school.

[GM2RN]

I agree with all of the excellent advice you have gotten already. I would add that you should do everything you can to orient yourself to where things are on your floor, and take some time to really look over the supplies in the omni. This will help tremendously with your time management since you won't have to search for everything all the time.

[shanishoe]

Thanks for all of your insight!