Working on a Neuro Floor

[jojofries2]

Hi all, I have been reading the posts on this for months, terrified that I would not find a job post graduation. Well that problem seems to have been solved as I was just offered a position on a Med/Surg Neuro floor at one of the local hospitals. Honestly, I really wanted to work ICU but as a new grad that went through an accelerated BSN program I really did not want to be overly picky. Besides I have a work contract with them as they paid for part of my schooling and I really don't think I had much of a choice unless I wanted to pay them back for the money they had already given me.

I would say I was upset by this but strangely enough I'm not. I am a veteran of Operation Iraqi Freedom and with the amount of TBI that is currently occurring in both OIF and OEF I am kind of excited to learn more about it. I also would like to work with veterans someday in the future so I think this would definitely be a good experience for that.

That being said I have no idea what to expect. Anyone have any advice about reading I can do or things that I can focus on to help prepare me for this? I just graduated from my program on Friday so the majority of my time now is going to be spend preparing for NCLEX. Thanks in advance!!

[MOM2B&C]

If you haven't yet taken the NCLEX, best of luck on that, and congrats on getting a job offer so quickly, and before completing NCLEX! My situation was very similar to yours...accelerated second degree, scholarship with a work commitment, AND my first job offer was on the neuro unit.

I was told that critical care units rarely hire new grads, so get a year's experience under your belt, and if you're still interested in ICU, give it a try then. In the meantime, if you have any opportunities to float off your unit (after you get a few months' experience), that's a great opportunity to see what other units are like.

Right now, just concentrate on NCLEX (if you haven't already tested). Beyond that, you should practice your basic neuro assessment skills. Review NIH stroke scale assessment (http://learn.heart.org/ihtml/application/student/interface.heart2/nihss.html), and familiarize yourself with basic neuro conditions (Stroke, seizure, MS, tumors, trauma, menengitis, etc.) and procedures (XLIF, PLIF, ALIF, crani). All your newly-learned skills will be used, because patients just won't conveniently stick to one medical condition, so your TBI patient may also have CHF and DM (and the solu-medrol will shoot the blood sugar to 450....), and maybe alcohol w/d as well. :nuke:

Observe everything you can, use all your resources, and don't be afraid to ask questions. You're going to get some wonderful experience!

[Munch]

I am not sure how your hospital is set up but where I work, I work on the neurology/neurosurgery floor. We get A LOT of post-op neurosurgery patients(the hospital I work at does A LOT of neurosurgery and the chief of the whole department is ranked the best in all of NY, PA, NJ and CT. So A lot of people come from out of state to see him and have their surgeries performed by him, not to mention the amounts of referrals we get from the suburbs the hospital is in Manhattan).

Anyway taking care of post-op neurosurgery patients can be a handful be rewarding as well, most of the patients I have cared for are in a lot of pain(depending on the surgery they have, we get a lot of cranis) so I do my best to keep them as comfortable as possible. Depending on the patients threshold for pain or the surgery performed and what the doctor ordered some of the patients get PCAS. I try to change the bag before it runs out so they aren't left waiting in pain while waiting for pharmacy to get the new bag ready, I also try to give them the clinician dose as soon as it's due. The patients without PCAS again they are usually ordered for Dilaudid(unless they are allergic)IVP and I try to give it to them as soon as they are due for it. I also try to give all the patients the medications they take at home on time. I myself had a crani and I was in terrible pain(I had it done at the hospital I work at by the chief neurosurgeon) and the neurosurgeon ordered me a PCA of dilaudid. The bag would run out and a couple of the nurses would take FOREVER to change the bag, same thing for the clinical dose. So I don't want any of my patients to go through what I did. When I am not on shift it's out of my hands but I like to prevent my patients what I went through.

Also with the neurology patients I do the same thing with pain control(if they are in serious pain from a concussion or something).

But be prepared as MOM2B&C said to do neuro checks and also some of the neurology patients who don't have an injury, be prepared to make lots of phone calls to the neurologist on the floor/on call because a lot of times they are out of it and the nurses can't control them. We once had a guy running around on the unit naked screaming, I once had an old lady who when I went in to give her medication(medication that she takes everyday mind you) she knocked the medication out of my hand on the floor.

So you never know what happens on the neurology/neurosurgery floor but I really do love it and my co-workers, despite the chaos(and sadly the occasional expiration of a patient).

[jamesy7]

I honestly thought I would hate neuro, but I love it and I am so fascinated by the different types of diseases and injuries I have encountered. You are right, there are a tremendous amount of TBIs and SCIs in vets and the skills you learn in neuro will be very helpful if you plan on working with the returning veterans.

The only thing I wanted to add is that you should brush up on biopsychology. Mainly how injuries (including strokes) in various parts of the brain can effect specific behaviors and functions. But for now - focus on everything that will be on your NCLEX! Good luck!