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How to Apply Your Nursing Knowledge on the Floor

This weeks installment of the FB Live episode is hosted by Heather RN BSN discussing how to apply all the facts, knowledge, and things that we learn during nursing school to the floor.

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Podcast Transcription

Hey guys. Welcome to our very first episode of our new Facebook Live series. This is something we’re hoping to do once a week, and every week it’s going to be a different topic. Most of the topics we’re going to pulling are going to come from the e-mails we receive from students. We love to get e-mails from students that let us know where they’re struggling and that lets us know what areas to focus on.


There are certain topics that are a little bit harder to respond to in person, or … I mean, on an e-mail. They’re a little bit harder to type out. We felt this would be a great way for topics like we have today, Applying Your Nursing Knowledge. It’s something that’s a little bit easier to talk about. If you’ve never done Facebook Live before, if you go ahead and just make comments as I’m talking, I’ll be able to see them right there on my screen and I’ll be able to answer them as I’m going.


I guess I should start off by letting you guys know I’m Heather. For those that haven’t seen me …


Hi John.


For those that haven’t seen me around social media quite yet on NRSNG. My name is Heather. I am a nurse. I went to school with Jon. Actually, Jon [Haws 00:01:11] had started NRSNG. I know you guys all know him.


I came on the team to work with the social media and community, and I answer a lot of the nurse e-mails.


Hi Tim.


If you see me saying hi or things like that or answering questions, it’s from the comments I’m getting below. Don’t think that I’m just crazy and talking to random people.


Hi guys.


Anyways, I guess we can get started. As we’re waiting for some more viewers to come on, if you guys want to grab a new cheat sheet that we created. It’s all on labs. It’s a really great cheat sheet to have. You can go ahead to www. … I don’t know if you can see that or not. I guess backwards. Sorry. I can’t write backwards. Www.nrsng.com/labs. You’ll just have to enter your e-mail address and you’ll get that new cheat sheet that we created. Really great for working on the floor or for any lab test you guys have coming up. It’s just a great resource to have.


Also, I travel around the mid-west for work now, and …


Oh! Thanks for letting me know.


I guess this looked right. On my end it looks backwards. That’s the web address to get that cheat sheet.


Thanks guys.


Yeah. Anyways, I travel around the mid-west right now as a nurse and I meet with wound care nurses and I help get their patients the supplies that they need. I’m actually travelling around Iowa right now and i am in a hotel. That’s that ugly paper in the back. Please ignore the background.


Anyways, I guess we’ll go ahead and get started with the topic for today. It is Applying Your Nursing Knowledge on the Floor. A lot of students contact us about this. It’s one of those topics that is, again, hard to let you know how to do it. It’s a hard topic to teach. It’s one of those things you have to learn. I’m hoping I can give you guys some tips today on things that you can bring to the floor to help you prepare and bring that knowledge that you’re learning in nursing school, on the floor, in real life.


Hi Jessica. I’m not too far from Nebraska. Where am I today? I even forget. I’m in West Des Moines. I’ll be towards Nebraska at the end of the month though. I’ll say hi.


Anyways. Yeah. I’m hoping I can give you guys some tips that I’ll help you when you get on the clinical floor or even when you guys graduate nursing school, pass your NCLEX and start working as a nurse.


I can tell you my first in nursing, when I wasn’t a student anymore, I thought that I had it covered. I interned on my cardiac unit as a student and I was lucky enough to get a job and walk right on to the same unit for my first job. I was super excited about that. I knew all the nurses. I knew how the floor works. I knew a lot of the patients that they saw frequently. I thought I was golden. Let me tell you, I was not.


It was chaotic my first day. When I went to nursing school, I went through a second degree program. It was accelerated, and we did our clinicals on Saturdays and Sundays.


As some of you may or may not know, Saturdays and Sundays seem to be a little bit slower. There aren’t as many doctors on the floor. They don’t run as many tests and procedures on the weekends unless they’re completely necessary. I didn’t have to learn to juggle all that.


My first day on the floor being a weekday, it was crazy ridiculous. I had to learn how to juggle so many different things. Granted, they didn’t just throw me right out there. That’s what preceptorship is for. That is why you have a nurse that you are following around and is there by your side so that you’re not just like thrown into the fire.


Hopefully, all your hospitals that you guys will be applying to in the future have some program like that, that teaches you what you’re going to be doing, because it’s a lot different.


Awesome Chris. Yeah. Cardiac is awesome, but I did night shift as my first job, but I precepted for a few weeks to start on day shift. Yeah, like I was saying. It was a lot to handle. I just want to tell you, don’t freak out. It’s the same for everybody. I’m already getting tons of comments that people who are on the same boat. I don’t mean to scare you. I don’t mean to scare you. It’s not scary. There’s going to be nurses there that are going to guide you.


Like I was saying, going to school is to prepare you for the NCLEX. Going through your preceptorship when you start your first job, that’s really what’s going to help prepare you for being on the floor and learning how to be a nurse.


School is awesome, because it teaches you all the book learning that you need. It teaches you the fundamentals. There’s so much information coming at you that it is going to be … It’s impossible  to keep it all in your head and know exactly when you need to use it. You need to take it in bits and pieces and you need to start with the basics when you get on the floor.


What I mean by the basics is follow your preceptor around for a couple of days. Hopefully they allow you to do that so that you’re not just jumping in and starting on your own.


I just got a question about studying for the NCLEX and how to retain that information.


We have some great resources that I can link you guys up to after I’m done talking about this specific topic, and I’ll leave those in the comments for some resources that we have to study for the NCLEX and how to retain knowledge. That is actually going to be another topic in a couple of weeks that we’re going to hope to hit on, is studying for the NCLEX and passing NCLEX. With NCLEX season coming up, we know that that’s going to be a big one. We are definitely going to be hitting on that soon.


What else did I get? Start nursing school. I’m nervous. Anything we need to know? Dos and don’ts.


We can hit on that too. [inaudible 00:07:18] Actually, they’re both programs that have been around for a long time. We don’t really like to recommend one or the other. A lot of our stuff is free. If you want to start there, that’d be great.


Anyways. What was I saying? Now, I lost my train of thought.


Yeah, go ahead and you want to start with the basics. You want to follow your preceptor around. Learn from that preceptor. Learn from that nurse. Not only your preceptor, you want to learn from all the nurses on the floor. I found that it was awesome to learn what different nurses do and take bits and pieces of their style and put it towards mine and create my own way of doing things.


There were certain things that I saw that some older nurses did that I loved and I thought was great, and I made sure to take note of that. There were certain things that I got from other nurses that I’m like, “Oh! I really like that too.” I went ahead and created my own system of how to do things on the floor. I think that that’s really important when you get on the floor to go ahead and apply that knowledge. You have to have a system in place. You have to have organization and checklist. Checklists were huge for me. I’m a very visual person. Writing everything down is important.


What I did when I first got to the floor was I always looked up every single one of my patients. Which I’m sure something that you guys have to do right now when you’re in class and in your clinicals. You have to go and do patient research so that you know all about your patients.


On the floor, obviously, you have a few more patients when you become a nurse. You need some extra time. I always went a little bit early so that I can research my patients and know exactly what I needed to know about them. I usually looked up their admit dates so I knew how often they needed vitals done. I look to see their medical history. If they’ve been there before, what are they there for now? Their admit diagnosis. Any notes that were already dictated by the physicians? Any test that they may have had already? Being on the cardiac floor, if they had a cardiac cath yet. I definitely made sure to check their cardiac labs to see if anything had changed drastically.


They may come in and their troponin may be low when they come in. As we all know, cardiac enzymes increase as time goes on. I thought that getting those labs and knowing all that information is really important. Also, the physicians. Knowing which physician to call for which area. They always are going to have a primary care physician and then if they’re on a specialty floor, they’re going to have a specialist as well. Knowing which doctor was on the case was also an important thing to know.


One of the things that I created …


Let’s see. Do you ever wish you worked somewhere else other than before precepted on your first job?


I loved floor. I think that I learned a lot there. I don’t wish that I worked anywhere else. I think some of the nurses could have been a little caddie on that floor. I’m glad that I worked night shift. They were super helpful. Night shift was a little bit slower. It gave me some more time to learn about the floor and to collect myself a little bit more and gain more cardiac knowledge. I really liked it. We also saw a ton of other stuff there. A lot of the vascular surgeons love to have their patients there. I saw a lot of vascular things.


A lot of the neurologist really like their patients there too. They just liked our nursing staff. They knew we were good. They put a lot of their patients there. I got to see a lot of things even though it was a cardiac unit. We also were duly trained to work in the cardiovascular intensive care unit. I got to see a lot over there too. If they were ever short nurses or if they were ever had a high census and they needed an extra nurse, they always pulled from our unit first. I really liked working cardiac as my first job. I really did.


How early did I arrive?


I wouldn’t say I arrived an hour or two early. You know what? Maybe an hour. I arrived probably about an hour early in the beginning just until I got it down. You don’t need to look up absolutely everything once you become a nurse on the floor. You don’t need to know … It’s important to know what meds you’re giving obviously, but you don’t need to have them all written out and you don’t need to know all their … You don’t need to write out all their reactions and things like that. Where in nursing school, I feel like they want you to write out a lot of that extra information so that they see that you actually have the knowledge base and that you’re learning it.


You don’t need to do that and you don’t need to have some crazy care plan before you go in. It’s more or less knowing the basics of your patient. Knowing their activity level. How do they get up? Just to be safe. I went to make sure I had the basic safety knowledge that I need to on my patients to care for them. I would say about an hour early is probably good. It’s, honestly, whatever you feel comfortable with. You just want to make sure you’re comfortable walking on the floor.


Anyways, this is what I created, If you guys want to take a look. As my organizational way to start my shift after I filled out information on each one of my patients on my reports sheets, also created this little handy tool that I would keep in my pocket. It had six squares, so that … On our floor we saw … We would have five or six patients at a time. We had a high patient ratio. It got crazy. Sometimes we only started with four, but it gave me some extra boxes. If we discharge a patient, I could cross one off and then I could always use the other side.


Anyways, it was a nice thing that I could just fold up, put in my pocket. I don’t know if you can see. Some of the things I would have written on here would be the room number, their admit date and time, because at our hospital, we had vitals that were routine. If they’d only been there for 24 hours, we had to do them every four hours. If they’d been over a day, they can be every eight hours.


I also put their primary care physician. I would write their name, their heart doctor. Obviously, if they were there for a cardiac, I would make sure to put that on there.


Meds. I wouldn’t write up the names of their meds, but I would write out med times. If they had 9, 12, 2 and 5 o’clock meds. I would make sure to write out the times and then I was able to just cross it off as I did it. That was my checklist of being able to keep track of where I was and making sure I wasn’t forgetting anything.


Activity level. It would be up times one, up times two. Stand in pivot. It just made it easy for me to be able to walk in a room, be like, “Oh, yeah. I need some extra help.” If they had their light on, I knew I needed to grab an extra help.”


I put a little section in here for test. If they have a cardiac cath that day, I knew that I had to prep them. I knew that I couldn’t give them certain medications in the morning, because they were getting … If they were getting any dye or anything like that, that gave me the heads up of what I could and could not give them.


Also, section for important labs. I might not write every single lab down, but anything that was important, I would make sure to put on there. If there was a big change and I knew the doctor was coming in and I wanted to him about it. I would go ahead and put that there. Sometimes I would even highlight it, color if I wanted to go ahead make sure I brought that up to the doc as he came in.


There was also a nice little empty section. I would have to write small, but gave me time to write notes. A lot of times during the day time, family calls in, they have questions. It help me keep track. When you have six patients, sometimes it’s a little hard to keep track of exactly what’s going on with each patient. It’s nice to have a spot to write notes. If you keep something like this in your pocket, super easy to pull in and out and just refer to it throughout the day.


Also, vitals and accu-checks at the bottom. If their vitals were Q4, I could write that and I can checkoff when I did them. Also, if they were in accu-check, if they were Q4 depending on what kind of … If they were on Prednisone or something like that. I would go ahead and have to have Q4 vitals or accu-checks, or if they were just the diabetic, before meals. Things like that. I would make sure to write the times down and it made it easy just to, again, check it off. I could always refer to this during the day, pull it out, see exactly what I need to do.


If they were getting discharged, I could write that down, because discharge paperwork is a whole another beast. It does take a lot of time to get done and to get a patient out. You want to start on that as soon as you know a patient is going to be discharged. That’s my fun little cheat sheet. Hope it helps you guys.


If you want to, I can maybe even make up a more professional one. Type it out on the computer and we can maybe post it or I’ll send it out as an e-mail if you guys are interested in that to start using that on the floor.


Again, like I said, learn from a lot of different nurses and take what you think is useful. If you found parts of these useful, take it with you and try it out. If it works for you, awesome. If it doesn’t, move on to the next nursing tip.


Yeah. I’m getting some comments that posting would be good. Maybe I’ll have Jon work on getting something like that posted for you guys.


Organization. Patient notes. Supplies. Keeping supplies on the floor. Not all of our supply rooms were always stocked very well. I found … Your prioritization is obviously huge in nursing, that’s why they make prioritization questions on NCLEX ranked a little bit higher than some of the other ones. That’s why they’re harder questions, because prioritization could be life and death for your patient.


You need to know which patient takes priority over which patient. When you prioritize, it’s great, and you can run into a room and you could get something done. If you don’t have the right supplies, you are having to run out of the room a couple of times and that just takes more time than you really needed to. I thought having supplies on myself, carrying them around was huge.


What I did was I had a tackle box. There’s a click video on this somewhere on Facebook that I posted a long time ago. I had a tackle box that I created that had all the supplies that we needed throughout the day on the floor. My tackle box is from Walmart. It was like $5 or $10. I don’t remember. It was super cheap. You are able to change the slots. I wish I had it here with me. Like I said, I’m in Iowa, not at home, so I don’t have it unfortunately.


I was able to change slots so I could put what I needed in there. Things I carried around were alligator clips for IVs. I carried … What else did I have in there? Post-it notes for notes. I kept … I don’t know. Just a whole bunch of different things in there that help me throughout the day. Things that I noticed. Gauze squares and band-aids. Simple things that you don’t think about, but if they’re not stocked in a room and you’re taking an IV out, trying to get a patient out the door so that you can get on to your next patient. Those things that you need right away. They’re nice to have.


Like I said. I carried on the tackle box. I taped this to the top so that it was always with me, and that made things a little bit easier for me to keep going and not derail my day by having to run in and out to the supply room to grab things all the time.


Practice. Practice is huge. It sounds really goofy to say, but practice when you’re at home still. Even when you’re not in school, using your books and going over case studies is huge. Get your hands on as many case studies as you can. You can practice at home with the case studies. It helps you learn to prioritize things so that you’re not feeling like you’re running around on the floor like a chicken with your head cut off. It helps you learn to do things on a simpler level at home when you have the time to think things through. The more you practice, the more things will just come naturally to you when you’re on the floor.


Like I said, you’re going to start with the basics. You’re going to start by doing an assessment and working slowly through and hopefully your floor doesn’t give you six patients your first day on the floor as a new grad, new nurse. They’re probably going to give you one, maybe two. Like I said, you’re going to have your preceptor with you so that you can ask questions. Don’t be like you’re alone in this when you go to the floor for the first time, because you definitely won’t be.


Ask questions when you’re unsure. You’re never going to look silly if you ask a question. Even if you think it’s something stupid. Even if you think it’s crazy and that they’re going to laugh at you. I guarantee you that they had the same questions when they were a new nurse. Believe me, as a nurse myself who got to precept students, I’d rather student ask me questions than just try and go do something on their own. It is so much easier to help a new nurse figure something out than to try and fix their mistake after it’s already happened.


Believe me, I made my own mistakes on the floor. I did. Luckily, they were not huge. As a new nurse, you need to ask questions and you need help. Sometimes things happen. Ask questions. Ask questions. Ask questions. I can’t say that enough. You’re never going to look down when you ask a question to an experienced nurse. If they’re a good nurse and they should be if they’re precepting you. They will be more than happy to help you and walk you through something that you’ve never done before.


As a nursing student, you don’t get to try everything on the floor. Sometimes, as a new nurse, it’s the first time you’re trying it on a person. Don’t let your patient know that. If it’s the first IV you’ve ever put in, hopefully it’s not. Hopefully … If it’s the first time you’ve ever put it in an actual live vein, don’t let your patient know that. You pretend like you’ve done it a thousands times to not make them nervous.


What questions do you guys have so far? Anything? I just feel like I’ve been talking and talking and talking. Hopefully I’m hitting on some things that have been helping you guys out.


Just practice. Work through things. Ask questions when you can.


John’s commenting on here. Have you done this before?


Of course. That is really what you have to say to a patient. There’s been plenty of times that I’d walked into a room and they’d be, “Oh! Have you done this before? Have you put in a catheter before?” “Yeah, I’ve done it a thousand times.” Did I have to tell them that it wasn’t on a live person? No. I’ve done it a lot of times on a dummy in nursing clinicals, but not on a live person, but they didn’t know that.


Let me tell you, catheters are not easy. Men. Putting them in a man, if you’ve done one before, you know, super easy, one hole, good to go. Women, it’s a little bit more difficult. Even experienced nurses have issues sometimes.


How long on the floor before I felt comfortable?


I would say after being with my preceptor, I felt pretty comfortable. I precepted on days for, I think, about three weeks, three days a week for three weeks, and then I moved over to nights, because that was the shift I would be working. On night shift, I got comfortable a lot faster than I think I did on days. It’s a little bit slower. You still get admits, but you don’t really have the discharges. You don’t have that extra discharge paperwork to do. It’s like the weekends and the fact that there aren’t any tests being run, your patients aren’t all over the place in the hospital. You have more time with them.


Obviously, they sleep. You still have to [pass 00:23:31] meds. You still have to do vitals. You still have to do all that stuff, but it gave you more time to think. It gave me some downtime. We did what were called chart audits at night. We had to go through every patient’s chart to make sure that everything was in its right place. Make sure that all the proper documentation was there. It gave me a lot of time to learn about my patient.


I would say working night shift. If you have that option, it’s a great place to start just because you have that downtime to do some extra things that maybe you don’t have time to do on day shift.


I would say probably a couple of months to get really comfortable. Even then, I still didn’t know everything and I had to ask questions. We have lots of different specialists on our floor, like I said, and different cardiac teams. A lot of it was getting to know, I’d say, a big tip for new nurses, is getting to know your doctors. Know what they like. Know which doctors you can put orders in for. Know which ones are going to yell at you. That’s huge, because you don’t want a doctor coming after you as a new nurse.


I don’t want to scare you with that by any means, but just learn who your doctors are. What they look like and what they prefer for their patients, because that’s huge. I thought that learning all those doctors was a big thing and I wish that they almost have like a chart for us when we started. I thought that would have been awesome. It would have been project that I would have happily taken up, but I just never had time to do it and never had the support. Something like that would be great for a new nurse.


Let’s see. Sorry. I got other questions on here. I’m scrolling back too.


How do you manage to break for a meal?


Night shift again. A little bit easier to break for a meal. There’s not as many people around. Nurses are more than happy to watch your patients. It’s a little bit easier night shift. Finding a time to eat during night shift. What time is a good time to eat dinner when you work on hours like that? I usually eat at 2:00 or 3:00 in the morning after I knew my meds were passed and everything was pretty much done.


I would give the same advice for day shift. You want to make sure, again, priorities. You want to make sure your top priorities are done. You want to make sure your meds are passed. You want to make sure if you have a patient going for a procedure, they’re prepped and ready to go.


On the cardiac unit, it was sometimes a little hard to find time to break for lunch. I’m not going to lie. There were lots of times I didn’t till 4:00 or 5:00, because if you have a patient going for a cardiac cath, it doesn’t take very long, but they get back and then they’re going to need constant vitals and checking to make sure everything is good with the site and that you’re not having to hold extra pressure because of bleeding. Things like that.


I would say fit in lunch when you can, or fit in a meal when you can. It might be quick. When you can, it’s definitely important to take care of yourself as well as your patients. Other nurses on the floor are more than happy to flip-flop with you too. I would partner up with a nurse and say, “Okay. You want to be lunch buddies today?” They’d be, “Yeah. Let’s do this.” As soon as one of us had some time, we’d go and give the other person a 15 minute warning, “Hey. I think in about 15 minutes I might be good for lunch. Are you good to take over my patients?” You work things out that way. That’s how I would recommend going for breaks and meals. It just depends on your floor too. Just depending on procedures and things like that.


Advice to somebody who’ve failed a semester in nursing school?


Failing can be hard and disappointing, I’m sure. I would just say get back up. You got to keep going. If this is your dream, don’t let anything stop you. We have many people that we’ve had on our podcast that Jon’s interviewed that had nursing instructors that told them that they would never be a good nurse. That they would never make it. That they would never pass NCLEX. Here they are years later and they’re an amazing nurse and they’re preceptors and they’re charge nurses.


Don’t let a class get you down or a semester get you down. Just get back up, brush it off and keep going. Study a little bit harder. Figure out … Look back and figure out maybe where you made the mistake. Did you maybe not study enough? Did you not study the right material? Did you have too much on your plate? Try and figure out where to go from there to not make those same mistakes again. Definitely, don’t give up. We would hate to see you give up if this is your dream. You’re going to do great, just get back up and keep going.


Neonatal nursing. Honestly, I don’t have enough experience with that. When I was in nursing school I actually nannied for a family and the mom was a neonatal nurse practitioner. She loved it. That is exactly what she wanted to go in outside of school. In nursing school, she went right into neonatal nursing as a nurse and then through that, she got to go back to school paid for by her program to become a neonatal nurse. She loves it. If that is something you’d like to do and that’s something that you dream to do, then yeah, go for it. Definitely go for your dreams. Go where you want to go.


I thought, originally when I went to nursing school, that i wanted to go into pediatrics. I thought that was the only place I wanted to be. I didn’t wanted to be anywhere else. When I even went through my cardiac rotation, I thought, “I am never going to be a cardiac nurse. I cannot hear these sounds. I can’t hear murmurs. I can’t do this. I’m not going to be a good cardiac nurse.”


I got into my preceptorship and got on the clinical floor and fell in love with it. Things changed. Definitely, if you dream of being a neonatal nurse and that’s where you want to be, I say go for it.


Actually starting an ER position in June as a new grad.


I’ve never worked in the E.R. I did a couple of rotations there. It is fast paced. There is a lot going on. I think that if you precept there and that’s where you start, I think you’ll do great. We could probably do a whole another edition of this Facebook life on E.R. with Susan. Susan is an E.R. nurse and she loves it and she’s got some great stories. I think she’ll be a great person to answer that question for you. We’ll see if we can get an answer for you from her.


Just because I’ve never worked in the E.R like I said. I think I did one or two quick rotations, not even full days in E.R. We didn’t have a trauma hospital where I work. I didn’t get to see too much of the crazy stuff that some of the other E.Rs do.


How did I adjust to the time change?


I was pregnant when I started my first job on night shift. I was in my first trimester going into my second. I didn’t sleep much as it was. I had pregnancy insomnia. I was up all night anyway. It was an easy thing for me to do.


The hardest thing for me was on my days off, staying awake during the day. I wasn’t really good at flip-floping. After my daughter was born, I was lucky enough. I think she was six months old and I got to switch to day shift. That helped even things out for me. The time change wasn’t hard to work the night shift for me. I was able to stay awake and that wasn’t an issue. I took naps during the day. I recommend blackout curtains.


Sometimes I would use meditation music just to help me fall asleep during the day when my mind just keeps going and everybody else is going around the house doing things and you’re trying to sleep like it’s night time. It’s hard.


Meditation music. Definitely darkening shades, because I could not sleep when it was light out. That definitely helped. Honestly, a lot of the girls I worked with said that they took Benadryl to help them sleep during the day if they couldn’t. I never did that just because Benadryl knocks me out for a couple of days. That was something that they did to help them sleep when they couldn’t. I just made sure to make it really dark in the room and listen to soft music. Honestly, I found it on YouTube or I would Google meditation music and just pull it up on my phone and put headphones. Excuse me. I’m sorry. Put headphones and that will help me sleep during the day so that I could be up during the night.


The part that stunk was on the weekends when family have things going on, sometimes I had to go straight from working a 12 hour shift all night to a family part. My dad decided to get married on a Sunday and I had to go straight from a 12 hour shift at night, drive up to Chicago and go to his wedding being eight months pregnant. That wasn’t fun, but you do what you got to do.


Switching back to days was almost difficult getting back in the routine of normal life. It probably takes about a week to make that full adjustment. I have a lot of friends that thought in nursing school, they could never do night shift. They were just not night time people. They couldn’t stay awake. Surprisingly, when that’s the only job you can get is night shift, you make it work.


I had a friend who did it for a couple of years and she thought she would never go back to days because she loved being home with her kids during the day. Even though she didn’t get much sleep, she loved it. She has recently gone back to days and she made it work too. You do what you got to do for your job and for what you love, and you never know, you might actually really like with nights.


How was your experience during your time in nursing school? Is it as horrifying as some people make it seem?


Nursing school. I think that Jon and I had a little bit of a different experience, very similar to what we here from a lot of our students though. Our program is very new. I think we might have been like the second class. I don’t know. Jon might have to correct. I can’t remember. We’re one of the first or second classes in this accelerated second degree program. It was a little disorganized. A lot of our professors were adjunct. Some of them could never talk before. They were just nurses who decided … They have their master’s degree and they decided, “All right. I’m going to be a teacher. I’m going to a nursing school teacher.”


It was a little frustrating at times. You do …


Okay. Jon corrected me. Second cohort. Yeah. We were the second cohort to go through the program. Yeah. A little disorganized. There were definitely some adjustments and some things that needed to be changed in the program. Hopefully we helped them with that because we were very vocal cohort. We did not keep quiet about things that we didn’t like.


That would probably be my recommendation to a lot of new nursing students is if you’re in a class and a teacher is teaching you something and you find something that disagrees in a book or NCLEX. Things like that. Bring it to their attention. Don’t badger them and don’t be rude. Don’t go after them. Don’t attack them.


Say, “Hey, I found this in a book and it’s different than what you’re saying. I’m just trying to know what I need to know for the real world and for NCLEX and to be a safe nurse. That’s really the most important thing when you’re going through school.” You want to be a safe nurse. You want to learn the safe things to do for your patient and to keep your patient safe.


If you don’t agree with a teacher, find out why they’re saying what they’re saying. That’s something that I would definitely advice you to do as a new nursing student. DOn’t be afraid to disagree. Not everything in nursing is completely black and while. A lot of nursing instructors make mistakes, that’s okay. They’re human. You want to make sure that you have the right information. If you think that your nursing instructor is instructing on the wrong material, go ahead and bring that up and ask questions.


How long did you work nigh shift before moving to day?


I think I semi-touched on this. How long was it? My daughter was six months when I went to days and I was pregnant with her … It’s probably nights for almost a year before I switched to days. When I switched to days, it was an interview process. It wasn’t just like, “Hey, I want to work days.” “Okay. You get this position.” It was a list of people who wanted to work days and it was a point system.


I had to interview for the position and it was based on points of how long I had been there. What certifications I had, and things like that before I was able to move on to days.


Some floors, if they have a day shift opening, they will let you walk right on to days. I have a friend who graduated a year after me and she worked on the orthopedic unit and they needed day shift nurses. She got to walk straight on to days as her first job. It just really depends on what floor you’re on and their need.


Fake it until you make it in front of a patient. Ask for help from experienced nurses.


Yes. Definitely, fake it until you make it. There is a point where you don’t want to fake it in front of your patients. If you don’t know how to do something and you think it might be dangerous, please don’t fake it. You like the saying, “Fake it till you make it in a lot of positions and a lot of jobs.” Nursing could be one that you don’t want to fake too much.


If you don’t feel safe giving a certain medication, or you don’t feel safe putting in a catheter or performing a procedure, like taking out a central line. If you’ve never done that before, ask for some help. A patient is not going to be super nervous or scared if you ask for an experienced nurse to come in and assist you with something. I think that they’re totally okay with that.


Tips for management related to documentations.


Sometimes I feel like it’s hard to find tie to document. It is hard to find time to document. Definitely, there are times that I would stay after my shift and have to continue to document. You don’t want to stay too late so that you’re not on the clock. You also don’t want to clock out.


It is a balance of finding time. Like I said, night shift, you have a little bit more time to get that done. During the day, there are times that you are just running around and you may have gotten every single one of your assessments done and your meds passed and then you sit down and you’re like, “Oh my God! I haven’t documented a single thing.”


That’s what was really nice also about this little cheat sheet that I had. It gave me spots to write if I knew I didn’t have time to log in to the computer in a patient’s room, even though that is probably something you should definitely do. I recommend logging into your patient’s computer in their room and charting right there by the bedside.


Sometimes you only have time to get the most important things in there and then you’d go back and want to type it in. You want to make sure you remember those things. Jot down in shorthand, on notes. I knew a lot of nurses that would grab a paper towel in the room and just write down quick notes on a paper towel. I recommend definitely taking notes so that you don’t forget things.


If you happened to do an assessment on a patient and you’re running around and you never got to chart it and you thought you were going to get to, but an emergency came up. Obviously, that emergency is a little bit more important than charting your patient’s assessment. I’m not saying that patient is not important. If they are healthy and breathing and peeing and pooping and doing all the right stuff. Take care of your emergency by all means and get back to charting afterwards. If you forgot some things, go on and reassess them.


Patients don’t know that you forgot them or that you didn’t chart something on them. You can just go in and re-list into them. There’s no harm in doing anything like that.


What made you become a cardiac nurse?


Like I said. I didn’t think I was going to become a cardiac nurse. I think when I was there for my internship, I just really liked it. I liked the floor. I liked a lot of the nurses that I worked with on the weekend that I was there. I think that made it easy to go to the floor. Also, the manager happened to be one of my clinical instructors for a different clinical rotation that I had and I got along with her really well. I knew her, so it made it a little bit easier.


At the end of my internship, I literally sent her an e-mail. I thanked her for the opportunity to be able to intern on that floor. Told her that i really enjoyed it. I thought that I learned a lot there. That’s, I think, one of the reasons that I went the cardiac route. Not only the fact that I liked the cardiac patients and the type of care that they did up there. I felt like I was able to learn a lot up there. A lot of people say to go into med surge right away after nursing school, because that’s where you’re going to learn the most. I felt like I got a ton of exposure to a lot of different things, even working on a specialized cardiac unit.


The nurses up there were just super smart. I felt like I learned a ton from them. They knew what they were doing. They knew what they were talking about. I think that’s really what led me to cardiology. I don’t even know if it was so much the cardiac aspect of it. Don’t get me wrong. I liked it, but EKGs terrified me.


I think even on NCLEX, I was still scared of having to read an EKG and know what it meant. They teach that to you once you get on the floor. I went through cardiac … After I graduated school and became a nurse and I was working on the cardiac floor for a while, I went through cardiac1, cardiac2, EKG1, EKG2, ACLS. They put you through a whole different type of school once you’re on the unit that you’re going to be so that you learn more of the specialized area that you’re going to see that.


That’s why I say, when you’re thinking about applying your nursing knowledge to the real world floor, it can be overwhelming. Just know that you’re not going to need absolutely everything and every disease process you ever learned on school on the floor that you work on.


If you work on cardiology, obviously, you’re going to need to know more of the cardiac stuff. You’re still going to need to know some of the other things that you learned, other disease processes because along with just a part failure, a patient is going to have a million other comorbidity. It’s important to know that and how they all correlate. Just don’t panic that you can’t remember absolutely every disease process, because they’re going to teach you and they’re going to help you in your specialty area once you get there.


That also doesn’t mean that once you get there and they teach you all the stuff and you decided, “You know what? This is just not the place for me.” Usually, after six months being on a floor, you can transfer within a hospital to a different floor and you can try something else up. That’s the great thing about nursing, is that it’s endless possibilities. If you don’t like one floor, you can go to the next one. If you’re thinking about cardiology, try it out. I think that you can learn a lot there.


As a new grad on [midnights 00:41:45]. Did you ever feel like you’ve had everything pushed off on you were left hanging high and dry?


I felt like sometimes, yes. It depended on the nurse you followed. I don’t like saying that day shift crapped on night shift all the time, because I feel like that’s where the animosity comes in between the two shifts, because I worked both shifts, I saw both sides of things. Day shift is super busy with procedures and doctors and families and admits and discharges. I understood the day shift side of things too of why there were certain things left for night shift.


Night shift does have a little bit more time to chart and do things like that. Yeah, there were some things that were left. There were definitely some nurses that I would follow that I would get to the floor and get my patient load and see what my patient load is going to be and I would see which nurses I had to go get report from and sometimes I’d be, “Oh my God! My night is going to stop.” Because there are certain nurses that you knew would leave stuff that they just didn’t want to do. I went in one day and had a clog to the [end 00:42:53] PEG2. It was clogged and she couldn’t get it unclogged so she just left it.


There’s definitely things like that, but I wouldn’t say it’s day shift versus night shift is much as it is as you’re going to run into some lazy nurses. All I can say is don’t be that nurse. Do your job. Try and get everything you can done and help out the next shift.


As night shift, we always had to create report sheets for day shift, but day shift didn’t have to do that for night shift because they were so busy. Makes sense. At the same time, there was some animosity from night shift to day shift that we had to do it and they didn’t.


When I did move to day shift, I tried to help out the night shift nurses by creating those report sheets. It’s just kind of … Think of it as if you wouldn’t want something done to you as a nurse, don’t do it to the next nurse that you’re going to have to report off to and vice versa.


Obviously, there’s going to be times that you slammed and there are things that you cannot get to. If they are not at the top of your priority list, you might just not get to them. They might get passed off to the next shift. Sometimes that happens. It’s going to come around full circle, so they understand. Just be up front and honest. Don’t just leave it and say, “Oops!” and act like they’re never going to know, because they will and then they’ll just get more mad because you just left it and you were lazy. Just be upfront and honest. If you didn’t get to something, just tell them.


Do med surge to get experience with everything.


Yeah. A lot of people are told to do med surge because they do see a lot of everything. I think that that’s a great place to go. If you don’t know where you want to go and you don’t have an area that you know you want to end up in eventually. Med surge is a great place to start for sure if you can get a job there.


Did I have many codes?


You know, surprisingly and luckily, when I worked, we had a few, but not a ton. One of the craziest ones that I could remember, I actually wasn’t even on our floor. I was [coding 00:44:49] to a different floor and I remember the code being called over the hospital P.A. system and I was on a different unit. I made sure all my patients were okay there and I asked to take a break to go check on my unit to see if they needed help. It was one of my friends and she had a patient that was totally fine and she walked out. The wife came out freaking out and the patient [inaudible 00:45:09] P.E., she walked in and he was just blue.


Yeah, that was probably the craziest one that we ever had on our floor when i was there. Other than that, we had a great rapid response team. Being on a cardiac unit, you have patients on telemetry 24/7. Anybody that up there has to be on telemetry. We got to catch things a lot quicker I think than some other floors. Some of the floors that are non-telemetry, unless you’re doing a check on a patient. Sometimes they didn’t catch things as quickly.


We were lucky at the fact that telemetry helped us. It gave us a heads up. We knew when a patient might be going downhill. We knew when to run in there and interject so that we didn’t have a ton of codes. That was pretty good I guess.


Were you hired as a graduate nurse or did you seek employment after you completed your boards [inaudible 00:46:00]?


I was lucky enough to actually get hired on before I took my boards. Like I said, after I finished my internship, I went ahead and reached out to the manager on the cardiac unit that I interned on. Thanked her for the opportunity and ask if they had any positions open. At the time she didn’t have any positions open and told me to keep an eye out because HR was supposed to be posting some soon. I literally looked everyday.


We had a ton of nursing schools in our area, it was like nurse overload. They say that there’s a nursing shortage everywhere, but when there’s a lot of nursing schools in one area, I feel like they’re overloaded with a lot of nurses.


There weren’t a lot of positions open. I was getting a little nervous. Yes, I checked the board daily for that cardiac position to be hosted. As soon at it was, I applied. I also e-mailed the manager and let her know that I applied. She’s, “Oh my gosh! I didn’t even know that that went up.” I didn’t even have to go through HR at that point. She’s like, “When can you come in? Can you come in tomorrow to do an interview?” That was pretty much it. I got pretty lucky in that aspect.


I highly recommend, if you are looking to work at the hospital that you go to school at, make sure that you are in good standings with the managers on the floors that you do your clinicals on. Don’t be afraid to reach out to them and to send them a thank you e-mail for allowing you to be a student on the floor. Personal e-mails or personal notes like that go overly long way and they will definitely remember you for that.


Sorry. My iPad is on 10%. Hopefully I won’t lose you guys.


What’s your take working as an OB unit as a new nurse?


Like I said earlier. If that’s something that you want to go into eventually. If you know, “I want to be an OB nurse and that is all I want to be.” I say go into it. There’s no reason to piddle-paddle around. If you can get a job on an OB unit as your first job and that’s where you want to be and that’s where you want to be forever, then I say go for it.


Like I said, I had a friend in nursing school that only wanted to be an OB nurse. She was actually CNA on that unit, and that’s exactly where she wanted to be and that’s the only place she wanted to be. She never wanted to be anywhere else in the hospital. Her theory was she didn’t want to deal with sick people. She wanted to deal with moms and babies and that’s where she’s been ever since. If that’s where you want to end up, then go for it.


[Inaudible 00:48:20] up second semester in nursing school, the job lined up up at home. My dream is to be in the E.R. Would you recommend try a few places?


You have a job lined up at the nursing home. If you have a job lined up. That’s great backup. I would recommend still applying to some other places. Some places, it’s really hard to get a job in a hospital. Up in a more populated area, like in Chicago. I had a friend move up to Chicago after she graduated nursing school and she had a really hard time finding a job in a hospital because she had no experience.


They wouldn’t hire her because she didn’t have at least a year of experience. She went ahead and got her year of experience at the nursing home. That allowed her to then move on to work in the hospital later on.


That’s up to you. If you know the nursing home and you like it there and you think that that would be a good fit for you, then yeah, take that job. If you want to learn more and get your assessment skills down a little bit better and see more of the acute care world, then I would recommend to go to the hospital.


You say your dream is to be in the E.R. I would definitely say interviewing, at least it’s in hospitals and seeking out some jobs at some hospitals would probably be a better start than starting at a nursing home if you want to end up in the E.R.


Good relationship with a patient quickly.


That’s a tough one. I would say there’s some patients you are going to get along with right off the bat. That’s just a given. I had a 90 year old patient. She was a frequent flyer. She was the sweetest lady you’ll ever meet. She woke up every morning and she’d put her make up on. She was super cute.


I hit it off with her right away. She was great. There’s other patients who are just crabby. There’s going to be those patients who think that staying in the hospital is like staying in a hotel and think that you’re [inaudible 00:50:12] every time you have to come in and check their blood pressure. Those are the patients that you might have to form more of a rapport with and to try and get on their good side.


You just got to feel out the patient. See how their personality is and how you guys mash. There are going to be those patients that you’re not going to sit and hold their hand and talk to them for hours on end. They want you to get in, do your job and get out. That’s fine.


To build a good rapport with a patient quickly, go in there, introduce yourself, act confident and let them know what’s going on for the day. That’s something I would teach any nursing student that would come in that I would be precepting, is to go in with confidence and just know what your plan is for the day.


If you know that they are going to be going for a cardiac cath at 10:00 in the morning, I would go in, say, “Hi. My name is Heather. I’m going to be your nurse for the day.” Write your name on the board. Write your CNA’s name on the board. Let them know that you’ll be around.


Explain, “All right. I’m going to go ahead and do a quick assessment on you. Then after I assess the rest of my patients, I’ll be back around with some meds. After we do meds, you’re going to be getting ready for your cardiac cath at 10:00. To prepare you for that, we’re going to do this, this and this. This is what’s going to happen in your cardiac cath. After you cardiac cath, you’re going to come back to the floor and I’m going to be in your room constantly doing vitals. We’ll do vitals every 15 minutes for about an hour and then we’ll switch it to ever half an hour for about two hours.” Walk them through the timeline of exactly what’s going to happen.


They’re going to have questions and just go ahead and answer them to your best abilities. If you don’t know the answer to a question, it’s okay to tell them that you don’t know. They would rather, I think, you tell them that you don’t than to give them an answer and then for that not to be right and for them to find that out later and then they’re going to be upset with you.


Be honest with them. Be open with them and just make sure you map out the day for them. I think that that is something that’s really important to patients. Being a patient myself in the hospital after having my daughter, it’s like you get a little delusional being in that room and nowhere else and just seeing those four walls. Knowing what’s going to happen during the day and exactly how things are going to pan out is really nice.


Also, they’re always going to ask you when the doctor is coming in and you’re never going to know. That’s just the story of doctors. You don’t know what time they’re going to round. Just be honest with them with that too, “Hey, this doctor usually rounds about this time. If you he has procedures or something like that, then it might be a little later. I can’t guarantee what time he’s going to come in.” Just be honest. Don’t ever lie to them.


Let’s see. I’m trying to go back and see if I have any more questions.


Did I gain more experience patient interaction on days or nights?


Even the days were busier. I think I gained more interaction with them on days just because they were awake more. Nights, they’re sleeping. A lot of our older patients had some downers. If they were normal during the day and coherent, they got a little crazy at night. We had a lot of different things like that to deal with. I think that I got to talk with my patients more on days, although we are slower at night.


By the time you had time to sit down after doing assessments and meds and getting your shift ready to go and started was about the time that they were all going to bed. There are those patients that were up and it was nice to be able to … When you did have downtime, it’s always nice to be able to just go and sit with your patient and talk with them and learn a little bit more about them and ease their fears if you can if they’re nervous about a test the next day. You definitely have more time at night to sit down and talk them through it.


I would have a lot of patients that were super nervous about cardiac caths. To me, it was a super simple easy procedure without a minimal risk. There is obviously a risk in any procedure you get done. Don’t get me wrong. It was easier for me to sit there at night time and talk them through the procedure and put them at a little bit more ease so that they could get to sleep.


Let’s see. Reading back at a comment Jon made. Sorry John. I forgot to give that [lactalis 00:54:37] until like five minutes ago. My bad.


That reminds me of a million times of patients going for colonoscopies and them not getting their prep during the day. Who wants to take a colonoscopy prep in the middle of the night? Nobody. If the GI doctor came in the next day and they were not prepped, they would be pissed. You have to do it.


Yeah. Definitely not fun to do in the middle of the night. You got to do what you got to do, and hopefully day shift doesn’t leave that stuff for night shift.


What else? Jon wants to know what other questions you guys have about codes, because he’s thinking about doing a longer podcast on that. If you guys have some more questions about codes, go ahead and post those too.


Sorry. I don’t mean to be awkward and quiet. I’m just trying to read through these to make sure I didn’t miss anything, because I’d hate to leave you guys hanging with a question that I didn’t get answered.


If I don’t get to every question, feel free to keep posting, because the video will definitely stay up on our website so you can refer back to it if you want to look at something that you missed. I can also go through and continue to answer questions through replies on these comments.


If you guys don’t have any other questions, I’ve kept you guys busy for the past hour. I’m sure that you guys have studying to do. I’ll let you guys go for the night.


Like I said, if you guys have ideas or things that you guys would like to see in these Facebook Live episodes, feel free to put comments down below or send us an e-mail at [email protected] and we will make sure to get those on our list and on our schedule for the rest of our live chats.


Hope you guys enjoyed this first one. Sorry if I was a little all over the place. Hopefully I answered most of your questions and help put you at ease a little bit about working on the floor.


Again, if you have any other questions, feel free to keep posting down below, and I will stay online and continue to answer those. Have a good night guys. Bye.


Date Published - May 5, 2016
Date Modified - May 5, 2016

Jon Haws RN

Written by Jon Haws RN

Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.