When did you....

dandk1997RN, MSN, RN · May 12, 2013

You are correct that you definitely should not be giving meds without the MD ordering them. That is outside the scope of your practice except in certain rare situations (like an emergent situation If you carry ACLS certification.). That being said, you will still use nursing judgement to initiate some treatments based on nursing diagnoses, like putting a pt in high Fowlers if they are clearly having breathing difficulties ("ineffective breathing pattern" or "in effective airway clearance") so it is good that you have practiced these things.

I'm almost a year into my nursing career. I became *really* comfortable with most of my day-to-day stuff around 5 months. I am comfortable with my understanding of most things I need to do at this point, and I am comfortable with my ability to get the info I need for most other stuff. I am getting better at handling rapid responses on my patients and am pretty darn good at helping during these situations with other nurses' patients. I am not as comfortable with true code situations yet. And for that, I am extremely grateful for my amazing (more experienced) coworkers.

It's pretty daunting at first and it does get better. It is completely normal to be nervous. The trick is knowing when you need help and asking before you get in over your head.

Good luck!

missnurse01, MSN, RN · May 12, 2013

it will prob take around a year, depending on where you start to work. You will drive to work in a panic of doing something wrong and go home thinking you did something wrong. Hopefully you will have an awesome preceptor and that will make it more enjoyable for you. Your clinicals should have you following a nurse and taking her load before school is over to get used to the whole pattern. You get to work, get report, write down what you have to do all day, asses your pts, and work on your list. That's it in a nutshell. ER is a totally different beast. Many things are done by protocols, you are expected to start the workup, altho usually not most meds, before the md sees the pt. You follow what is the protocol for certain complaints. ex: abd pain, female pt: u/a, preg test, start IV, draw and send labs, set up for pelvic. It's the same for nearly all of those pts.

don't get overwhelmed! you will not be expected to remember everything immediately!

sbostonRN · May 13, 2013

Took me about 6 months at my first job. Then I changed jobs and it took me another 6 months before I felt confident doing that job. The learning never stops!!

HopefulNurse2011 · May 13, 2013

Thank you so much for replying! Im starting my last term so I feel this is where we will get the bulk of our hands on between med surg 3 and my capstone. So the nurse managers and coworkers are not expecting us to remember/know everything?? What a relief! Lol I feel everytime I learn new info some old info gets pushed out (not just nursing info lol) and I dont realize it until the day comes and I'm trying to remember a bday of event lol. Ive heard from other nurses the true learning doesnt come until u actually start on the floor as a nurse and the books are just info that wont make a whole heck of sense until you can actually apply it...do you feel this way? For instance I can explain what im looking for with someone experiencing rht or lt.side heart failure but in the actual situation will I know? Kinda psyching myself out.

HopefulNurse2011 · May 13, 2013

Thank you so much for replying! Im starting my last term so I feel this is where we will get the bulk of our hands on between med surg 3 and my capstone. So the nurse managers and coworkers are not expecting us to remember/know everything?? What a relief! Lol I feel everytime I learn new info some old info gets pushed out (not just nursing info lol) and I dont realize it until the day comes and I'm trying to remember a bday of event lol. Ive heard from other nurses the true learning doesnt come until u actually start on the floor as a nurse and the books are just info that wont make a whole heck of sense until you can actually apply it...do you feel this way? For instance I can explain what im looking for with someone experiencing rht or lt.side heart failure but in the actual situation will I know? Kinda psyching myself out.

SNB1014, RN · May 13, 2013

it is never wrong to be cautious.

when you get a job, get to know your unit protocols very very well. there are certain labs that i know are abnormal (read: not critical) but if i know the doc usually makes rounds in the am, i will wait and seek them out and say "hey, i wanted to let you know so and so's K is elevated, do you want to do something about that?"

sometimes the lasix, according to pharmacy, is "due" at 9am. well at 9am i am giving all my BP meds, anti arrhythmics ad perhaps pain rx. the last thing i want to do is bottom out their pressure, if they are like ehh, say 107/35 (which i get more often than i'd like). so i hold the lasix and i give it after breakfast maybe an hour and a half after the bp meds and they gave drank some.

technically, oxygen requires a doctors order. well, if my pt needs oxygen, im not going to wait. if they arent doing so hot with 4L nc, i will place them on a lower venti mask, get my new VS and call he dr, and say, hey, this is whats going on. would you like me to do anything else, or anything different?"

its a fine line...and some doctors are like "why did you wait for me to call you back? ??? just order the abg and then call me so i know its on the way!!!"

others are like "I DIDNT SAY YOU COULD PLACE THEM ON A VENTI MASK!!!! but um, yes, keep them on that"

if someone needs a fluid bolus d/t hypotension but they are a heart failure pt, run it slower than you normally would run a bolus. it just makes sense.

these are things you will get a feel for. i still am struggling with that myself. in my facility and my unit anyways, i am not afraid to initiate some things because i know they are right and that the md will write a specific order later, if they want. i wont get introuble because i placed oxygen on a patient....i will get in trouble if i let the patient become hypoxic and resp arrest, you see?

good luck!

missnurse01, MSN, RN · May 13, 2013

I just wrote a reply and the computer ate it!!!!

anyway, the gist of it was that you get the practical application of your knowledge. Like driving a car, you can read and learn about it, but it is when you physically do it that it all clicks in your head. Some people have an easier time of this than others, and your gpa does not give a good indication of how it will be for you. ( 'book smart' vs 'street smart').

don't worry about it. Relax, be a sponge, and you will be fine!

calivianya, BSN, RN · May 17, 2013

Don't worry. Wait until you have your capstone, and if you really feel unprepared when that is done, start worrying. Everything feel into place for me in my capstone experience. It really makes me question why all clinicals aren't like that. There is no point in following a SINGLE patient for a few hours. It's ridiculous. Nursing school clinicals need to be entire 12 hour shifst where a student nurse can see and understand the ENTIRE work of the nurse. I feel like none of my clinicals were helpful at ALL up until my capstone.

By the next to the last week of the capstone, my preceptor was following me around, but mostly just being silent while I passed all of the meds, did all of the assessments, gave report to the oncoming shift, called the MD, called pharmacy, etc. I planned out what was going to happen at the beginning of the shift, she'd ask me what my plan was, and I'd tell her. She'd usually say that's exactly how she'd do it anyway and didn't have any corrections. It was scary the first couple of weeks, but your capstone CAN be doing the job of a nurse if you make it happen. The patients are still the nurse's patients, so if you seem afraid and show no initiative your preceptor will do the work for you. If you throw yourself in there and make it clear that your goals are to manage x number of patients alone by the time you leave, get comfortable talking to the docs by the time you leave, and to give thorough report on all of your patients to oncoming staff, your preceptor will help you get there. I have no doubt I'll feel uncomfortable again when I actually start working at a new job, but I was feeling relatively comfortable in the unit I was in and managing a full patient load by the end of my capstone. I hope the same is true for you. :)

Nurse_Jessie · May 18, 2013

Starting as a new nurse is scary. I'm two months into my first nursing job and I worry about making a mistake every shift. A lot of nursing practice and routines will start making a lot more sense during your capstone experience, and then when you get your first job, don't be scared to ask questions. They don't expect you to know everything. Take every learning experience you get and make the most of it.

When I started working, I found that providing nursing care wasn't as difficult as I feared, it is the time management and documentation that has been my biggest challenge. Getting into good organizational habits early is the best advice I can give you.

I work on a Critical Care unit, so my day likely looks different from a Med-Surg nurse or an LTC nurse. When we get in we get shift report and then we all choose our patients for the day. In general, we try to balance out the difficult and easy patients. Then I get report on my patients. We do bedside report at my facility, so during report I'll assess for specific concerns such as neuro checks, cardiac cath side assessments, or assessing skin breakdown or other wounds so that the previous nurse can confirm that the assessment is the same as her last, or highlight any changes in condition.

Once I've received report I spend a few minutes reviewing my patients most recent lab results, looking over the doctor's order and taking a look at medications. Then I plan out my day. I highly recommend that you find a "nurse's brain" or similar nursing routine sheet that works for you. It is invaluable later in the day when you are busy. Jot down anytime that the patient has the leave the floor for procedures, medications, topics to discuss with the doctor when he/she is on the floor, etc. Then I start my assessments, charting, and administering morning medications. From there my day really depends on what is going on with each of my patients.

Remember that you have learned a lot in nursing school, and you likely remember more than you think you do.

HopefulNurse2011 · May 25, 2013

Omg this advice is clvery helpful. My clinicals havent been great at all. Didnt do much primarily bc my program is new so getting good clinical sites is difficult. Ive had 2 nursing home qhich after giving meds theres not much more. My mebtal health was a lot of observation, peds was a lot of health assessment interviews and vitals, intradermal shots etc bc we were at a juvenile det. Center. Ob I gave a few meds, post partum assesment and vitals on mom and baby. Med surg 1 I gave ONE pill and performed 1 GI assessment. Smh but the good news is my capstone and med surg 3 is a the same hospital which is our huge public hospital and level one trauma center so im certain I will get to do a lot. And it doesnt hurt that I want to work there. I really want to focus on my assessments, documentation and time management.

ClassyChristina · May 26, 2013

I am three months into my first RN job on an Oncology floor and I am still waiting to feel comfortable. I ask a lot of questions and just have to be patient with myself! You can't know it all! The good thing is that everyone starts out this way. We have good company! : )