I remember my first day of clinicals...armed with my "NCLEX hospital" first-semester education, I thought I was pretty haute shyte. I'd mastered insulin injections (on a hot dog), staple removal (on a wash cloth), and figured there wasn't much that could be tossed my way that I wouldn't have a snappy reference to, courtesy of "Iggy", my trusty med-surg book.
Enter the real world, where getting that Foley in on a combative female patient is a hell of a lot different than placing it in one of our perky (and conveniently immobile) skills dummies, and the urge to take the time to listen to the repetitive tales of your early-onset Alzheimer's patient is superseded by the urgent need to administer antibiotics to the pre-op in 112-1, pain medication to the post-op in 112-2, and determine whether 113-1 needs that emesis basin now or three minutes ago; all the while hoping that some unnoticed and unprotected part of you didn't accidentally brush up against the bedrail of the confused C dif patient in isolation.
It is with these things in mind that I offer you, nursing students and brand-new nurses, a few insider tips to help you navigate those first few months as a rookie RN:
1. If your job does not require all-white shoes, don't. Just don't. You will have all manner of viscous, serosanguinous, emetic, phlegmatic, coffee-ground, noxious, and vile liquids land on them. You will step in it, have it soak into your laces, seep into the seams; and no matter how often you wash them, there are some things that will leave an indelible stain that will be instantly recognizable to all of your co-workers. Just don't.
2. Never make fun of the surgeon wearing purple Crocs.
3. Many of your patients and/or their families will have acquired their WebMD. They will opine on vaccination, "Big Pharma", extol the virtues of their chiropractor/Shaman/midwife/laysurgeon, and generally preface every remark with "well I just read on naturalnews.org (insert idiotic medical conspiracy and reference to David Icke book)"! Do not argue with them. Refer all comments to their primary physician. Try to eavesdrop on that discussion.
4. Make friends with the rad techs in your hospital. Gifting them with the occasional box of chocolates or trip to the vending machine can pay off big in terms of entertainment value.
5. Find out who, on your unit, can decipher each doctor's handwriting. In time you'll learn, but until then, you'll want to avoid having to call back Dr. M at 2:30 am to figure out what she wrote at eight pm.
6. Speaking of calling the doc...do not even think of paging him until you have a full set of recent vitals and the patient's chart in front of you. Replying "um...I don't know..." when he asks what the patient's age or BP is will not cut it and will garner you an icy "Why don't you page me back when you have all the information" if you're lucky, and a ten-minute tirade questioning your education, comprehension, and abilities if you're not.
7. You do not need five pounds of tape, scissors, alcohol swabs, pens, markers, calipers, hemostats, extra O2 tubing, calculators, notepads, highlighters, rulers, penlights, tongue depressors, gauzes, swabs, thermometers, NaCl bullets, gloves, lancets, iodine swabs, drug reference guides, and hand sanitizer in your pockets. While it's nice to be prepared, (and nice for us to be able to hit you up for tape or alcohol swabs in passing), all that is going to happen is that every single bit of your equipment is going to come flying out of your pockets during a code or in the midst of inserting that Foley on your previously sweet and helpful suspected kidney stone-turned banshee patient. Pens, tape, and alcohol swabs. Borrow whatever else you need off the other new grad on your shift.
8. If you wear contacts, always bring a spare pair or your eyeglasses. You don't want to tear or lose a lens right before you have to start an IV on your dehydrated flu patient.
9. Don't drink a ton of coffee until you can go an entire twelve-hour shift without peeing. You don't want to be doing the potty shuffle while rounding with the new peds intern.
What other helpful tips would some of you medical vets give to new grads?
Oh, forgot one! #10: get a watch with a metal or rubber band. You do NOT want a nice leather band (remember the shoes?)