January 19, 2009

20 Things Every New Nurse Needs to Know

1) Be patient. Whether you start out in ICU, Med-Surg or Psych, understanding your unit and the complexities of nursing only comes with time. Don't feel like a dummy if you don't imediately know everything. More than likely you won't and that's ok.

2) Give yourself a good year before bailing. It takes a lot of time to get into the swing of things and to really feel like a nurse. Our instructors always told us to give ourselves a year. I didn't believe them. They were right.

3)Ask questions. Don't ever assume anything. Assumption can only lead to mistakes and you can't make mistakes with people's lives. Ask. Ask. Ask and ask again.

4)Learn your unit. This is so simple, but I cannot tell you how many times I have had to ask where certain paperwork or supplies are. Take mental inventory of your environment. Not only will this save you time, but it gives you a lot more independance.

5) Get organized.
Oy.....organization. I cannot tell you how many times I have gone into a patients room to remove and IV and forgotten the gauze and tape. This leads to trampsing all the way back to the supply cart which is usually in the farthest location from where you are. The majority of my night is spent running up and down the halls for things I need. This is something you learn with time as well.

6)Buy comfortable shoes! I cannot stress this enough. If you are going to be doing bedside nursing you will be running your arse off and doing that with aching feet is excrutiating. I wear Nursmates and I can honestly tell you that my feet have never hurt......EVER! This doesn't mean that they aren't tired and that my legs don't sometimes just ache down to the marrow, but my feet never hurt. I wear this pair and as a testament to these shoes I will tell you that I bought them my last semester of nursing school and they still feel great. That's a lot of mileage for a pair of shoes.

7)Buy a good stethescope!
Oh, the stethescope debate. I have bought 4 steths since starting nursing school. The first one I bought because it was cheaper. The other two because I upgraded and wanted two diff colors (girly, I know) and the third because I realized the the last two reasons were completely shallow and ridiculous. Yes, I have 4 all together, if you did the math. My last, and most favorite steth is my Littman Cardiology III stethescope.
The Littman brand is the cadillac of stethescopes and you WILL get your money's worth out of this. The acoustics are amazing. I can actually hear the blood filling and pumping through the chambers and if you aren't great with breath sounds, such as myself, then you'll become a breath sound expert with this. I have doctors request my steth when I'm on the floor because they can hear the best with it. Invest! Oh, and get a good name tag or have it engraved because people will STEAL! Shameless, I know. I ordered mind in plum and I love it.

8)Don't beat yourself up. You are going to make mistakes, you're new at this and nursing school only gives you a small perspective on what to expect. I can't tell you how many times I went home crying because I felt like a failure. You will feel this way too, prepare yourself. And if there ever comes a time when you feel like you know everything...stay away from me and my family. No one knows everything and it's scary if you think you do.

9)Always work as a team. Nursing is about teamwork, not about who can run the quickest code, who can chart the fastest or who has the most knowledge. There is no "I" in team folks. :)

10)Spend your first paycheck on yourself and no one else. You freaking earned that much, at least. You will work your ass off to become a nurse, endulge a little and enjoy your new earnings.

11)Leave work at work.
Once you hand over your assignment, do your best to let it go. You can't control everything and just like you shouldn't bring your personal life to work, it can be just as damaging to bring your work life home. Move on and let the day go.

12)Be proud! Nursing is a highly trained & skilled profession. You are a professional and carry a license, just like a physician. You are trained in anatomy, physiology, disease processes, pharmacology, assessment, critical thinking and judgement and much more. You are programmed to be a nurse and even if you don't feel like one sometimes, you are one. I am very proud that I am a nurse. I know I complain a lot, but at the end of the day, I feel good that I was able to change someone's life, if only in a small way and sometimes in a large way. It's very gratifying. Not only that, but you will learn that doctors often times respect your professional opinion, so don't be scared to offer up some of your knowledge and advice. I have done this many times and it, surprisingly works to my patients benefit.

13)Trust your Instincts!
You are trained to think critically and to trust your judgement. Nursing is a very independant career and sometimes you have to make decisions based on your knowledge alone. If you feel something isn't right, don't ignore it, do something! More than not you are right. It's better to be safe than sorry.

14)Have Integrity. Please, please don't ever do anything shady. If you give a wrong med....say so. If your patient falls...report it. If you see someone do something unethical...tell someone. Your license is on the line and your patients life is much more important than you getting disciplined. I gave a pt the wrong dose of medication once. My conscience ate away at me and I reported it. Do the right thing. PLEASE!

15)Don't take it personal. You will start working with seasoned and possibly older nurses who learned things differently than you. They will grill you at report sometimes and make you feel small. Try not to take it too personally. Your both there for the same reason...the patient's best interests. Also, don't let them inimidate you. They will try....beleive me. There are many ways to do things and their way isn't always the best or "right" way, but be open to their suggestions too and remember....they know more than you. Be respectful, even if you drive home cursing their name. LOL

16)Never lift or move someone without help!
If you break your back you are out of a job and your family will suffer and guess what...the hospital could care less. Welcome to the real world. Unless someone is in major distress, there is always time to grab someone to help you lift and pull. Many times orderlies are assigned and on call in the hospital just for that reason alone. Use them. It's their job.

17)Chart everything. If a patient has an emesis...chart it. If they walk the halls...chart it. If they pull out the IV...chart it. If they refuse medications....chart it. Cover your ass...always.

18)Always rmember to prioritize. This can be very tricky at times. If you have a pt calling for pain meds and you have one calling because they can't brethe...who will you see first? The answer is obvious. Pain never killed anyone, but not being able to breathe can. Yes, the pt who's addicted to the dilaudid you've been pushing may complain about you, but the one who was possibly dying will remember your efforts forever...hopefully.

19)Double check everything. Remember your 5 rights. Right Medication, Right patient, Right time, Right dose and the right route. Check their arm band. Have them state their name and DOB. Make sure it's the right med, correct dose and right time. And please, please make certain that you aren't sticking something in their IV that the doc wants IM. I've done this...arg. The patient loved it....lol.....but I felt like a dumbass. (Rule of thumb....IM meds last longer because it's in the muscle, IV is a quick fix with a shorter duration...straight to the bloodstream, PO meds take longer to absorb, but last longer too).

20)Believe in yourself. You know this stuff. Believe in yourself and don't doubt your abilities. It's all there, give it time to sink in and never become complacent. There is always something to learn, so take advantage of it. If a new skill comes up...ask the nurse if you can watch or if you cn perform it under his/her supervision. The best way to learn is to do it. Yes, it can be daunting and overwhelming, but unless you jump in and get your hands dirty you won't learn and don't you want to be the best nurse you can be? I remember blood administration was such a difficult skill for me because there is so much involved, but after a few times doing it, I don't need help anymore and that feels good.

Being a nurse is so rewarding. I love seeing new grads come into the field and having them ask me questions always takes me aback. What startles me more, is that I can answer a lot of their questions and it feels good. I'm still learning. Everyday I learn something new and I love it. I love seeing all the male nurses enter the field too. They are just as competent and caring as us women are and they always come in handy when moving a large patient too. Ha ha.

I hope you can get something from these tips, they are from my experiences alone and what I have learned most, is that I still have so much yet to learn.


pinky said...

That is good advice Christy. Looking back on the last 10 years of my life, I would have to agree with what you have to say. Except the litman. Mine was stolen!!!!! But yes, it is a great stethscope and if you are doing Med surg or tele it is a great idea.

I do L&D and maternal child health. We usually have litman steths at the bedside or hanging around the unit.

I have had 2 spine surgerys and am not teaching Clinical to Nursing students due to these injurys. So yes take care of your back. And if you do have a back injury, don't do L&D.