First Year Nursing Advice

Having been on the floor for a year, I've gained some insight, knowledge, and helpful tips that I think can help other nursing students and newly licensed nurses entering their first year. Keep in mind that your floor might vary from mine and your routine could be much different, so tweak as needed. But generally, for my journey, this is what I've found to be helpful.

1. Read your patients' notes. Doctor's notes, other nursing notes, consults, etc. This will give you a well-rounded grasp of what your patient is going through, what to keep an eye on, and keep you updated on their current condition and plan. I always try to think like a doctor, but act like a nurse. What that means is trying to challenge myself to think critically and understand doctor's notes as much as possible to see where their brains are heading given what symptoms the patient is exhibiting, why they ordered certain labs and tests, etc., but interacting with the patient with the human touch.
2. Find your own way to organize your patient report/cheat sheet. Every nurse takes, gives, and records report in their own style. Generally, report consists of giving patient updates, outlining the plan of care, and giving the next nurse the heads up on what to look out for. We (try to) use the IPASS system (Illness severity, Patient summary, Action, Situation awareness/contingency planning, and synthesis from oncoming RN). When I first started my job, I was very task oriented and basically operated on a list of things to get done throughout the day, so much so that I forgot to keep an ongoing assessment on the patient.  My reports also sucked - they were basically just me repeating my head-to-toe assessments. Having grown out of that style, my cheat sheet of my patients has evolved to become more comprehensive. This way, I don't miss anything. Also, some nurses really tear you up if you don't know what you're talking about or leave something out . . 
   
3. Deal with the patient's most important need first. This might be seen as kissing ass and taking shit from a difficult patient and giving in. But what I've actually discovered, at least with the patients I've worked with, is that once you tackle the item they care about the most, it makes progressing along the plan of the care much easier and thus, makes your shift much more bearable. If a patient's top priority is pain (and someone's always in pain), give them their pain medicine first. Treat their pain before you tell them the rest of the plan for the day and explain the other things they have to do, because they won't listen to you and understand the importance of doing those things if they don't feel like their important to you first.
4. Don't forget the people touch. While they're laying in their hospital bed, their a patient. They're a sick body waiting to be treated to go back to life outside of the hospital. Life in the hospital is actually a little dreadful. You think it's hard to be a nurse? Well, imagine how hard it is to be a patient. To be confined to a bed for most of the bed, be bored out of your mind, not be able to crack a window for fresh air (even when Florence Nightingale wrote in Notes on Nursing how critical fresh air was for human health and ventilation way back when), and not be able to enjoy a nice comfortable bed or enjoy the things they did before coming in. Especially if it was a sudden, acute-onset sort of thing. What do you like to do on your days off? Hiking? Snowboarding? Hanging out with family? Going out with your friends and drinking? Nothing at all? Well, what if I told you you can't do those things for as long as you're in the hospital, because for most of the patients, this is what it is. I once rotated on a psychiatric floor that didn't even have space for exercise, and yet a critical and arguably essential part of mental health is physical health. People are often don't realize how lucky they are to be able to wake up every morning after uninterrupted sleep and literally have the time and resources to do whatever they want. So don't forget that the person laying in bed is a real person. A real person who, outside of the hospital, has real hobbies and maybe a real job and family and things that make them laugh and cry and get them excited for life or bum them out. Like you, once they leave the hospital, they're a totally different person. Don't forget to invest the time to find out how. I always try to learn an interesting fact or story about the patients I take care of.

• "I love looking at maps. I could sit down and teach you about highways all day."
• "I work in an autoshop. I love engines and cars . . " *Commence conversation about horsepower, body kits, racing, blah blah, all the shit a girl never understands. . *
• "I don't play guitar much anymore but that guitar's beautiful. Black detail on white. You don't have to play for hours everyday to get good at it. Fuck it you know, just pick up a guitar for a little bit everyday and before you know it you're playing."

The list goes on.

Workflow often impedes us from getting to know our patients. But I can't imagine going throughout the day without stopping to talk to them as if they weren't sick at all. It would make coming home from work so bland. And I am so not about that life.