Episode 33:

How To Survive Your 1st Year As A Nurse

Turnover rates for nurses in their 1st year are above 20%, meaning 20% of nurses leave nursing within their first year. Nursing is one of the most stressful jobs out there, so how do you go from a nurtured student to a self-sufficient nurse?

On this episode’s news; are standing desks really worth the investment?

SHOW NOTES

 

Current News

Standing Desks, Are They Worth IT?

There’s a new trend that you may have heard about and that’s the standing work station or standing desk. Many people argue that standing is healthier than sitting, but is a standing desk really worthwhile?

What we do know

Some people label sitting as the new smoking but does that hold as fact? There has been some research done on the effects of prolonged sitting. 

According to Mayo Clinic, there is a list of negative consequences of prolonged sitting those include; obesity, increased blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol levels. Those conditions were shown in people that sat for more than 8 hrs a day with no physical activity. 

However, the studies also showed that 60-75 min of moderate-intensity activity countered the effects of prolonged sitting. Moderate intensity includes a brisk walk (4 mph), mowing the lawn, heavy cleaning (vacuuming, window washing, washing the floor), or biking at a light pace (10-12 mph). 

Other studies show that there is a drastically increased health risk for people that sit for 12 hours compared to 5.

This is all good research, however, most studies don’t take a look at what the individual is doing outside of sitting. A lot of people, like nurses, work at a job that involves a lot of walking or other physical activity.

Sitting shortens the hip flexors, tightens the lower back (which causes disk problems), weakens the glutes and weakens the core. Sitting isn’t natural for us.

What are the claims

1. A standing desk can help with weight control, high blood pressure, diabetes, and cholesterol.

  • Sitting burns 80 cal/hour vs standing at 88cal/hr. Not much difference in calorie expenditure. According to Mayo Clinic, you can counter the negative effects of sitting by 60-75 min of moderate activity a day.
  • If most of your work is done sitting and you don’t exercise frequently a standing desk may be helpful. Not so much if you’re a fit individual and you’re seeking to lower your chances of those issues. 

2. It helps reduce back pain. 

  • Many people can verify that sitting for long periods of time hurts their back, especially for people with sciatica. I can attest to back pain with prolonged sitting and do stand when I am on my computer sometimes. What I find helpful is walking around for a few minutes every hour or so to stretch my legs. Your hamstrings are flexed during sitting keeping your muscles in your glutes tight and pulling on your back and rotating your pelvis, which attributes to back pain. A simple solution is to do what I do and walk around. You can get a standing desk to take tension off your muscles and lower back.

Personally, I do not think a standing desk is necessary unless you find yourself sitting at a desk for 8 hrs or more with little physical activity. Some people find it comfortable to stand and work, even I do it sometimes. Standing desks go anywhere from 200 – 1000’s of dollars if you do not want to dish out that money I recommend walking around for a few minutes every hour or doing some stretching while at work. There is not enough research to suggest grand health benefits but I do see some benefit in them. 

How to survive your 1st year as a Nurse

We’re approaching our 3rd-year mark since we became nurses. We can all attest that the people you’ve once worked with are no longer there. 

The NSI, Nursing solutions inc, collects nursing-related statistics like turnover rates and staffing reports. Their 2019 report showed the turnover rates for nurses. Hospital turnover rate is at its 10-year peak at 19.1%. Over twenty percent (22.9%) of all new RNs left within a year. The first-year turnover accounted for over a quarter (27.7%) of all RN separations.

The first year as a nurse is always the hardest. There is a lot to get accustomed to. Clinical just barely touches the surface. There’s the orientation, which impossibly crams “everything you should see” into a 10 – 13 week period. There is no formula for how to nurse, there’s no script on what you should say to the patients, and there’s no one size fits protocol’s to abide by, except for the multiple core measure that you won’t fully grasp until a few years down the road. Nursing is one of the more stressful jobs out there, so how do you go from a nurtured student nurse to a self-sufficient nurse? Keep reading. 

Tips to get you through your 1st year as a Nurse 

The first couple of points are something that every nurse should hear.

1. You won’t know everything and that’s ok. Every patient’s goal of care will be different. No matter how long you have been practicing, you haven’t seen everything. Even the nurses that say I’ve been here 20 years, I’ve seen everything, they’ll be asking you a question or 2. Don’t shy away from new experiences because you think you know everything or that someone will judge you because you don’t know. Remember all your coworkers have been in the same position starting off, they won’t judge you. Although some might have forgotten that they were a new grad at one point, so just forget about those nurses, they’re usually crabby anyways. 

2. A bad shift doesn’t make you a bad nurse. There are days that we feel accomplished about everything we did plus more. There will be days that just kick your ass. There will be days that you will ask yourself “can I really handle my career”, you’ll feel almost incompetent at some point or another. Sometimes, those days seem endless. We will be the first to say that a bad shift does not make you a bad nurse. As a nurse, you’ve touched so many lives, even in your first year. For every bad shift, you have or going to have, you’ll have 100s of great ones and just imagine how many lives you’ve changed and add their families. Many nurses take everything to heart and taking a loss once in a while takes a toll on them mentally and physically. It takes them some time to recuperate and get past their bad shifts. For those nurses it’s ok you will get through it just keep working. A friend to vent to always helps, remember to talk it out.

3. Talk to your coworkers. You need to be a team player to stay in this field. Some of the causes for nurse turnover is poor relationships between coworkers and picking up the slack for coworkers. Poor relationships start with poor communication. Getting to know your coworkers is very important for not only patient care but also for your own health. Your coworkers should almost be viewed as your friends. You have to get to know each other to build a bond, you can even create outside of the workplace friendships with the people you work with. Try to get to know at least a few nurses, your day will flow better and you’ll get to socialize in the workplace. Yes, even nurses can have fun in the hospital and that can be a good stress relief. When you can bond on a social level you build synergy and work better as a team. You need to have fun, especially in the nursing field.

4. Learn to prioritize. This is a learn by day process. If you don’t know where to start, asking questions in orientation is great, if you’re out of orientation you can ask your preceptor, unit educator, or any other nurse. Go from highest importance to lowest. Things you should always have; penlight, scissors, 2 pens, marker, few flushes, alcohol wipes, and stethoscope. 

Report > MAR/Labs > (Plan) > assessment > Meds > (Plan) > Notes > Chart  

  1. LOC, orientation, vitals and pain
  2. Head: PERRLA, smile, and turn head.
  3. Upper body: shrug, lift both arms, grip strength, and pulses
  4. Lower body: lift legs, move feet, wiggle toes, and pulses
  5. Lung sounds, heart sounds, bowel sounds, and abdominal palpation. 
  6. Skin, wounds, lines, and tubes.
  • That is a good method because during the report you find out why the patient is there, what was done that shift, what’s currently going on, and prior assessment. Write it on a report sheet.
  • MAR/Labs are next because you want to get an idea of what you are currently treating the patient for. Hydralazine is blood pressure management and insulin drip is blood sugar management so the patient might be post cardiac surgery. Or if you check the vitals and you see a systolic of 160 you’ll be less worried because you know he has metoprolol on and will be given when you walk in. Labs are also good to look at prior because a patient might be on a Lasix drip and his potassium was 4.0, 6 hrs ago and your starting to see some PVCs you’ll know to draw some blood after your assessment. Or platelets are 95 and the patient is scheduled for subcutaneous heparin so now you know to hold it and can explain why. Look up meds that you aren’t familiar with or to double-check their use. You can also start to plan out your day.
  • Start with line reconciliations, what drips and where are they going. An assessment should be done in a timely manner. This lets you compare the patient’s current state to their prior. Has anything changed? What’s different? This is your head to toe.
  • Now that you have your assessment is it appropriate to give the prescribed meds? Is the heart rate 56 but systolic 160? Should you give the metoprolol. Use nursing judgment but if unsure ask a nurse or page the physician. This is your chance to educate that patient tell them what meds they are on and what they do. It’s a good way to help you memorize the meds as well. After you give your meds it’s good to plan out the rest of your night; when do drips need to be changed, what time are my other meds due, when should I do my bath, is there an x-ray, and when should I change my dressings. 
  • Take a look at the physician notes or the test results. Some physicians write really good notes and outline everything that has been done for the patient. It’s a good way to know what the plan of care is. For example, the patient is having runs of afib or vtach and is on an amio drip and a note says there is a future plan for ablation if the rhythm isn’t controlled by amiodarone, now you know what’s going on.
  • Charting is self-explanatory. Just remember if it’s not charted it’s not done. Takes up a lot of time but you’ll get better at it as you go.

5. Self-care is a must. A key part of self-care is not taking your work home with you. Let the patient stay in the hospital. When we bring our frustrations home it tends to ruin our days and the days for our significant others. Try not to feel stressed about work on your off days. There have been multiple days where we were nervous or anxious about coming into work for the next shift. It’s hard to get passed in the beginning or after a stretch of rough nights, but you have to know that you cannot predict what will happen so it’s best to not focus on it and what has happened in the past is over with, it’s a learned experience. No one will think or remember more of your bad shifts than you, so let’s try and at least forget about them while we are home. Stick with your hobbies. Make sure you keep doing things that make you happy. Keep going rock climbing, keep working out, keep going out with your friends, and stay focused on the good things in your life.

6. Listen to your patients. Our patients come from all types of backgrounds with unique stories. Having a tough shift? Ask the patient what they used to do for a living it makes the care more meaningful and you develop a relationship with them. Our patients are really interesting individuals, even the confused ones. You can learn how they ended up in the hospital and how their health has progressed. You’ll even learn that some patients don’t exactly know what’s going on and you can help clear things up.

 

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