Take the first 30 minutes after report to look over orders, read notes, and plan your shift. Don't just jump into the fire and try to piece it together as you go. If you have a plan in place for how you're going to manage your time, you'll be less likely to get derailed when something unexpected happens.
Try to work all your shifts in a row if you have the option, and get your patients back. By the third or fourth shift, it'll be easy because you know everyone and what to expect
Have an idea of what you’re doing, some nurses I work with sit down after/before report and write down what meds are due when and what labs are needed to be drawn. Just so they have a schedule and don’t need to open the computer everytime.
Time management is the biggest player for medsurg units, day or night shift. Youre gonna have alot of meds, and depending on the specialty of the unit. but it doesn’t take long to get into the swing of things.
If something is late or due in 20 minutes? It’s fine, as long as it’s not blood. You’ve got an hour on either side of the med to pass it, use that hour as you need it. If you want time out of that persons room because you need a break? Use it. Or, if you need time to chart- give that med early to give yourself a break and stay ahead of schedule
You're a new grad and you're still trying to get into the rhythm of things. My advice is to keep your chin up, don't get frustrated when you're a bit behind because it happens to everyone! Ask for help when you need it! In due time you'll be going through everything in a breeze
Med-Surg, in my opinion, is a great place for a new grad to start out. It forces you to learn a little about a lot in a short amount of time. I'm a CMSRN now, but I work mostly in inpatient rehab. My Med surg days helped me become a better nurse in my opinion.
the first year is exhausting- you are learning every second of everyday always. And as a nurse in general, you'll continue to learn new things always. Keep in mind we have all been there and have gotten through. Don't lose faith! Prioritize your time and manage it wisely. Yeah, easier said than done. I know! Figure out what that means for you and your patients. Make yourself checklists- I still to this day organize all my Med pass times, diagnostic tests, and new orders. Each patient gets a "to do" checklist on the back of my report sheet for them, and I try my best to follow it everyday. Memorize your normal lab values and the MD consults names and how to get in contact with each of them if needed
I find that making myself clear lists of what I have to do (meds, discharge teaching, etc) and want to do (showers, etc) at the beginning of the shift really helps. Then I can look at what I can delegate to care aides (usually this is baths/showers, and I will prioritize people for them).
During the day, if someone offers to help I actually try to think if there's anything they can do for me. There's no point in being a martyr, if someone can do a med pass or dressing for me, I will absolutely take them up on their offer. If I have free time, I offer it back. Being very clear about what you need and what you can offer is huge. I'll say things like "I have a half hour before my next med is due, is there something I can do for you in that time". That lets them know that I'm willing to help, but I can't take on a complex dressing I've never done before or something like that.
what has been a lifesaver for me is making check lists with little boxes for each patient. Meds and their times, showers, discharge, consents, all that jazz. It also helps me to consolidate my care so I don't have to keep sitting down at the computer/asked to do things/looking at the emar in between med passes.
make notes of what you're learning, how your practice is improving, and what you accomplish - if you can sell the experience the manager on your dream unit will snap you up.
Make a check list if you have a hard time remembering. Try to document as you go, dont save it all for later. Example: you have about one min left of documenting when a patient requests pain med. Finish the document, the pain med can wait a min. And prioritize the important stuff. Example: a patient wants a glass of water but you have 3 K-riders to hang. Hang all the k-riders first.
Everyone makes mistakes just don’t get in a hurry and take shortcuts so you don’t make the big ones. This also requires you to make the most of your time so cluster your care and learning to delegate are crucial. Also chart as you go (as much as possible), obviously this will vary but it will help you realize what is important and what can wait. Lastly I would create a sheet to help you keep up with mandatory charting items that you can check off when completed that way you don’t have to worry about it.
If you're not sure about a medication or dose/timing/interaction call your pharmacist.
If you have multiple infusions going follow your line from the bag to the pump and double check it's programed from right med/ rate. This will prevent you from being the RN who accidentally boluses a whole bag of heparin over 30m instead of the antibiotic, I seen this happen.
If you're not sure whether to call a rapid or not, call the rapid. If you think they're about to code blue call the code blue. Fuck people's attitudes, keep your patients safe.
Some nurses are miserable burnouts but some of us really enjoy teaching. Make yourself available for help when you can and people will invest themselves into helping you as well, but don't let your self get swamped and drown sometime you gotta know when to say you no.
If you don't feel safe doing something, let's say a femoral sheath pull for example, then don't do it. Most skills will feel intimidating but you won't get better without being willing to learn and do (with proper educating/observing/ and someone experienced with you).
If you're not sure whether or not to call the doctor about someone/something just call the doctor. Stick up for yourself when they're rude, you gotta set limits with them and patients too. You're a nurse not a door mat. If they wouldn't talk to you like that in a Walmart parking lot don't let them at work.
Practice IVs whenever you get a chance. You'll probably suck at first but eventually it clicks.
Chart every time you notify a Dr of your concern or a critical value/ patient concern.
If a patient threats to AMA run to the desk for the paperwork and back to the patient as fast as possible before they change their mind.
Don’t be afraid to do your own thing, chart your own assessment. Don’t worry about what the last person charted. If you’ve assessed them and you see something else chart that and just take your time reading orders and following through with your tasks. You’re gonna have to figure out your time management because you will be juggling a lot of different things and that in itself can frazzle people and lead to mistakes. Write stuff down and give yourself reminders! And of course ask for help when you need it. Don’t drown in silence
For me, finding a good brain sheet and one of those multi-colored clicky pens were lifesavers.
I'm big on color coding - I wrote report notes in black ink; times for med passes/tasks that were due were written in red ink; anything new that came up during the shift (like condition changes, procedures, new orders, etc) were written in green. This helped me manage my time and prioritize accordingly, and it also helped me better organize my report at the end of my shift.
No matter the situation, dont rush. Dont be afraid to ask questions. Make to do lists throughout your shifts and find brain sheets to take report on. Time management and organization is key.
. On your first days and really your first months of nursing just be open to listening and learning. If anything seems like a mistake stop and get some help. Experienced nurses should expect you to have lots of questions and not know much and if they demand way too much of you then it may be an inappropriate work environment. They should all expect you to be fresh and ready to learn, not ready to hit the ground running.
Look at the trends in the vitals. Err on the side of safety. If someone is inappropriate or rude to you and you don't feel like you know what to say back it's ok to just say "thats inappropriate" and leave the room and get your preceptor. The patients are not your boss.
the best thing is to show up with a pocket-sized note book and pen, and just let the information wash over you. Write down people's names, especially the ones you can go to to ask for help/info in the future. Relax and allow... you are about to get a tsunami of information headed your way, and you will trip yourself up if you are trying TOO hard to memorize everything all at once.
our hospital should have a medication reference guide somewhere in your charting system. Don’t give a medication you don’t know about; if you don’t know it, research it! As a general rule, I never what to give a med without knowing 1) what it is 2) what I’m giving it for and why 3) how will I know if the medication is effective or not 4) what side effects are benign and expected and which ones are much more serious.
Focus on your med pass, but also do your assessment and flush your ivs during it. Start charting your assessment in the room with the things that are abnormal like edema, skin issues, crackles wheezing etc. You can finish your charting later. Start with your easiest patient who take meds whole/all at once and save your patient who is total care for the end. Give your insulin when the blood sugar is checked & check your vitals when they come in.
Try to tidy the rooms and keep supplies that you know you will need, don’t be afraid to throw away things that are just extra clutter. For example I had a pt with a gi bleed needing to be changed every 15 minutes or so, I kept a whole thing of briefs chux and wipes in there.
Never go without laying eyes on a patient longer than 2 hours. We round on odd hours and the cnas round on even hours. I cannot tell you how embarrassed I was to call a code on a pt I saw last 4 hrs ago. I was having to sit with one of my pts who was trying to get oob and doctor wanted to avoid restraints
I absolutely hate when I’m doing my med pass and none of them have anything to drink so I’ve started checking when I go in at shift change or just take a cup of water with me bc it’s on the way from the omnicell. Saves me a few steps
My concept was sort of like a day timer page, hourly by hourly along the left and would write my room numbers along the top with a column for each, then say at 1500h write "I&O" under the particular room number, or meds for which room under the particular time, or any other particular tasks which did not fit neatly into this also had a further to do list .
ED nurse here. When we have boarders the main thing is the effing meds. OMFG there's usually a ton of them. You usually have a 2 hour window to get them done so start those 0900 meds at 0800 and hopefully be done by 1000 with all the other crap you need to do.
I tell this to all new nurses… sit back, take a breath and just breathe… you will feel like you’re drowning for at minimum, a year. Never leave a question unanswered (your own questions I mean), don’t doubt yourself, and if the $hit hits the fan, you will get through it.
For your anxiety - make sure you're taking care of yourself. Plan social time with friends/family. Exercise. Practice good sleep hygiene. Eat good food. Try HeadSpace meditations, or journaling, or something else to help you relax after an awful shift.
For your professional growth - if you come across something new at work, jot it down. Then on a day off, take like, 10 minutes and look it up in one of your old textbooks. Or find the policy on your hospital's intranet. Or use Khan Academy videos on YouTube.
Don't forget to prime the IV line before connecting it to a pump. Dont forget to label IVs
When you get home after every shift, leave work things at work. The moment you take off your work uniform is the moment you stop worrying about things related to work. Don't think about your should've, could've and would'ves. My clinical educator gave me this advice and it has stuck with me since. I find journaling helps too. If you want to talk about the crazy shifts you've had, write it down! Journaling helps to organise your thoughts and helps you look at things at a new perspective. I find journaling at night helps clear my head before I sleep.
When things you've never seen pop up and you don't know what to do, just ask! Don't worry about what other staff would think! You're only starting out so you don't know these things yet. If it's a procedure you've never done before, look up your hospital's policy and procedures, and shadow an experienced nurse. Then, do the procedure under their supervision.
Make a detailed shift planner and refer to it all the time! It will be your guide. Write down the things you need to do for each patient for each hour. Write down any devices/lines they have (IV, drain tube, IDC, PICC, etc.) so you know what monitoring you'll need to do. Make sure you know what your patients have come in for, or are they a pre-op or post-op patient? This helps you know what to expect when a Dr gives orders. Or if a Dr is new and they don't know what they're supposed to do, you let them know what the patient might need. Idk about where you work but here, we're always given a paper handover for each shift for every patient on the ward. On the handover it tells you each patient's diagnosis, history, social background, mobility status and current plan for them. If you don't have that there, write it down on your own shift planner or brain? I think that's what some nurses call it..
If you want every little detail of the patient's history and inpatient timeline then you'll have to come in early to look at the chart. It's not the off-going nurse's responsibility to regurgitate this information. After a few weeks (or however long it takes you) of getting used to navigating the chart and learning what information is truly relevant to the patient's care, you'll become more confident receiving report.
I've never been the type to come in early, but I have coworkers who have been nurses for years and still come in early to look up their patients. Sometimes they know more about the patients than I do by the time I give report.
When I used to work medsurg- first thing I would do is block out my papers like 07/08/09/10/11/12/13 etc for medications. I wrote down all my medications and the prns. Then I would look at all of their labs and write down what was important. Was Na high? Was K low? Was creat and BUN high? Did they have a nephro consult? Then I’d look at nursing orders and if they had q6 hr bladder scans or vs rechecks or anything scheduled I’d put it in the block with the times so when I passed their meds i wouldn’t forget about what else needed to be done for them. And different patient problems call for different prioritizations. Say with stroke patients- the goal (if it’s been longer than 24hrs) would probably maintaining ideal blood pressures, working with physical therapy or speech, and getting them rehab appropriate if needed. With ESLD patients it would be to monitor their PT/INR if they’re scheduled for a paracentesis that day to know if you need to get FFP or PLT ordered to make sure it’s appropriate. Or if they’re Covid- trending their labs and seeing how to wean/titrating their O2 requirements as tolerated.
Find out their medical history. Major things like diabetes, CHF, COPD and other comorbidities. What did they do to stabilize the patient? Then look at orders. Ignore the fluff. Are they on scheduled nebs? Antibiotics? Diuretics? How much and how often? Do they need I&O? Then look at the previous shift note and MD note. Look at the most recent labs. Is their weight trending down? Are they improving? What’s their plan? Check case management notes as well, it’s often pertinent info. Everything else you will figure out as the shift goes.
SLOW DOWN. Think critically about everything you are doing. Do full assessments on your patients. Why exactly are you giving this antibiotic? What side effects might you anticipate? Do your five (or 27 idk what number we up to anymore) rights. Is Bob's breathing actually normal? It's probably not ok for his RR to be 32 even if the last shift says he's always like that. It does not matter if that that losartan is going to be late. Do you think old Bob takes his medication on time at home? Hell no he forgets to take every other night. In fact, he doesn't even think he has hypertension. Don't be rushed by the patient or family member demanding to see you right now. Patient safety comes first
Actually, scratch that your safety comes first. Then patient safety second. Don't ever put yourself in an unsafe situation to try and make a patient or family member happy. I did that and my back is still hurting me. They want you to magically hulk them up from the bed? nope. You need multiple staff members to help you or a lift. If they have to wait, then let them wait.
Cluster care as much as possible. If a call bell has been ringing for more than 5 mins and everybody’s busy and you’re caught up with pertinent charting please help out. If not and there’s no other emergency going on, focus on your patients and then help out. Also, chart appropriately. State facts, not opinions.
Let’s make a career where we support each other and work together as a team; no belittling each other, talking down to each other, avoiding helping each other, trying to make each other feel stupid or inadequate, etc. We are stronger when we work together; remember that as you gain new knowledge, experiences and skills. One day, you’ll be the experienced nurse and grad nurses will look to you for advise and will observe how you treat your colleagues and patients.
1.ACCEPT that fact that you will indeed make mistakes. You are human learning how to take care of other humans. 2. TRUST your gut. 3. ADVOCATE for yourself 4. SELF CARE is a must, take those days off don't pick up extra, enjoy them 5. SLOW is safe. Speed comes with experience.
TRUST YOUR GUT!!! Doesn't matter if you're new, life experiences have helped you form your intuition, trust it, especially in unsafe patient situations.
Please ask questions. Before you “fake it til you make it”, just ask.
Take the time to know what is going on with your patient. Why are they here? What's the plan for them? What is their code status? It might be just a my hospital problem but last week I got handover for 5 patients and was told that only 1 was DNR. When I looked through the paperwork 4/5 were.
Find out as soon as possible who are the more experienced nurses that you can rely upon. Many of us love to support you. Use your references to look things up on the floor. My first year I kept my Davis Drug guide memebership and it was very helpful because it is geared toward nursing. Don't hesitate to call the doc or the pharmacist. Keep notes. I have a googledoc that I have added to over the years and it is 48 pages long! Organized alphabetically and I can access it from my phone. This saves so much time when there is some detail I need to recall in a hurry.
General Nurse Advice
I'm a case manager (social work side), and my nurse counterparts constantly talk about case management as being a huge blessing to them so they could get off the floor.
Healthcare is a thankless job 99% of the time, and will very rarely reimburse you what you’re actually worth. That being said, once you put in your time in the “trenches,” and get some good experience - you will start to see what niche you fit into. You will also notice the jobs you stumble on will be less demanding - as nurses it’s my experience that the cushy jobs are reserved for nurses that have “earned” them, or are taken by people that have the right “friend”.
Another thing I did was get a job at the VA!! The VA has tremendous benefits and retirement. You also won’t kill yourself working like in the private sector. VA is a great place to be an old nurse!! And the pts at the VA are waaaaaay better and nicer
If you are an everyday RN, then work in an ER or IcU overnights per diem. That will give you too pay, top differential and critical care bonus. Also, some places compensate for certifications like CEN, TNCC and so on. I make over $44/hr.
getting various certifications may not bring in more pay directly but would give you a competitive edge to higher paying jobs over other candidates.
Be aware the first few years you will get crap jobs and the lower pay. There isn't a nurse shortage. Those employers whining they can't keep nurses are those paying almost nothing and pushing nurses to do questionable things. Only after you have a little experience can you start being picky about where you work.
Quality of life > $$ in salary.
If you want to see real money with little in the way of intellect or schooling, check out device reps for medical devices. They work like 30 hours a week and absolutely kill it.
Medical sales is ludicrous. A girl i went to high school with who is clinically brain dead sells dialysis equipment for Davita and is now pulling in upwards of 60k base with +25% target sales incentives of half her base, meaning if sales goals are doubled, she rakes 120k in bonuses.
I remember a couple years ago a local paper in my hometown published a list of the 10 highest payed county employees (Cook County so that's Chicago + a chunk of the north shore/west burbs.) The highest paid county worker was some nurse who worked a shit ton of overtime. It was crazy, she made more than Daley, more than the county treasurer, more than Chicago's police chief. Nurses can definitely make bank.
if a nurse continues her education, she can eventually get a position as a CNO or other executive type position and beat that 150 if they are so inclined. Before anyone dismisses this, the odds of someone making partner in big law are just as low and making it into the hierarchy as a nurse.
Anyway, you know what is awesome about nursing? You can generally pick the amount and type of hours you work- My friend's mom puts in a straight 40 and takes the rest of the week off. And when you go home... you go home. No one is emailing you, you aren't sitting at home living in fear that an MD is going to call you to bang out a really important change to an excel file no one is going to remember existed in a few months and ruin your chances of making it out to your friend's birthday that night.
On a side note... there was a mention of pharma sales reps. Holy crap do they have it made. Schmooze all day, and if you are selling a halfway decent product and work reasonably hard you can kill it and make way more than your CEO. I will take it a step farther and say any sales job where you are selling relatively niche high value products is the quickest way to early retirement
How about becoming a nurse practitioner and basically being a junior doctor. No piss or shit. Back home the NP was the only one i ever saw.
Nursing is a great field if you are the type of person who likes to keep growing. Most nurses get comfortable and they don’t continue their education or stop getting certifications that will help them move up. If you want to do it for the money make sure you pick the right specialization and be ready to study a lot
Become a nurse practitioner. You will make a lot more for a couple more years of school. If she is ambitious and gets her NP, she can make a ton of money. There is a shortage of GP doctors so you are seeing NP's take on more and more responsibility.
Always negotiate the salary, even if it’s a government or nonprofit job or a range is advertised. Wait until they’ve made an offer, then ask for at least 10% above what’s posted/offered, then negotiate down. Have specific reasons ready why you’re worth the higher salary—all the ways you surpass what’s listed in the job ad / job description.
Don’t befriend anyone at work, and don’t even get chummy with them for the first six months. It takes at least that long to begin to see the office politics at play. Never speak negatively or gossip about/to coworkers. Be warm but keep it professional; if you need to cry or scream, go to a bathroom stall or your car. Do not socialize with coworkers and DEFINITELY never date coworkers. Do not add them on social media until you leave the company/org.
Arrive five minutes early, leave five minutes late, but never work a bunch of overtime—especially if uncompensated!!! Never let them see you sweat. Even if that means you do slyly put in some extra work or research off the clock. Never get complacent. Take initiative where you can—look for ways to save or generate money; create concise but impactful unsolicited reports for your boss and working groups/committees. Figure out your supervisor/s’ communication style/s and cater to that; don’t waste his or her time, but present your work and requests in a way you know will get their positive attention. Never volunteer for anything else—especially part of someone else’s job description, and never EVER offer to take minutes or get coffee unless you’re the secretary and that’s in your job description. It should go without saying but... learn proper grammar, usage, syntax, spelling, and business comms—sadly, this will make you stand out nowadays, especially to older and/or well educated, conscientious supervisors.
Take your career seriously but never make it your life or identity.
Last but not least, you do not owe the company anything. Take your PTO's and annual leave if you have it. Don't work overtime and don't ever do more than you are paid to do. All it does it hurt you and the company will shove you under a burning building to save themselves every single time.
Every time you clock out retire. Every time you arrive at work be as grateful as you were on the first day.
