Med-Surg Nursing: Top Tips for New Grads

You made it through nursing school and landed your first job in med-surg nursing. Now what? It’s about to get real! Don’t worry, this guide will help you out. I’m here to share all the most important tips to prepare you for your life on the hospital floor.

Med-Surg Nursing Tips For New Grads

I remember when I first graduated and started my new job. I was so excited! But also scared… Really scared.

And overwhelmed.

After all these years, I want to reassure you that you will learn the ropes and it will be okay – but it will take quite a bit of time and diligence. You won’t walk in on day 1 and do this perfectly. You’ll mess things up… be inefficient… forget things… say things wrong… miss things… but that’s all part of the process of learning this new skill. Please don’t beat yourself up if you’re not perfect immediately – no one is… not even the highest-performing new grads.

These are my tips for new med-surg nurses.

If you prefer to watch video, check this out:

Learn the discharge and admission processes backward and forwards

The one thing you’ll be doing the most is discharging and admitting patients. Med-surg units have a lot of throughput, meaning a lot of patients coming into the unit and going out. While you might start out with 5 patients, you most likely will not end your shift with those same 5 patients. You’ll probably discharge 2-3, and admit or receive transfers of another 2-3.

Sometimes, I’d end my shift with a completely different set of patients than I started out with!

Each unit has a specific process for receiving admissions and transfers, as well as discharging patients. Invest some mental energy into learning these processes, the sooner you can be efficient at doing them, the easier they become. They will not go away! You’ll do this multiple times each shift.

It might be helpful to make a cheat sheet/checklist of what your unique unit does for each admission, transfer, and discharge and tape it to your clipboard for fast reference. You could even make a note in your phone. I often found myself asking the same few questions over and over again, or really wanting to make sure I didn’t miss anything – having a written reference to walk through to make sure you’ve done all you’re supposed to is incredibly helpful, can put your mind at ease, and help you complete them faster without having to track down your preceptor to double-check your work.

Get a great report sheet

Report sheets are important to get used to as you familiarize yourself with a unit. And don’t beat yourself up if it’s tough to get into the swing of things with the report. I get it – I was there. I focused so much on the report and it became big stress for me because it felt like my report card. If I had to give a report to a really unkind person at the end of a tough shift, it was a major morale blow.

Similarly, if I started a shift without a systematic way to organize the insane amount of information I received at the beginning of the shift – I’d start out very scatter-brained and not sure where to focus. I like to think of the report sheet kind of like a funnel… you gather all the information at the beginning of the shift at the top of the funnel and synthesize it into actionable steps.

Don’t make the mistake I made and switch sheets at the beginning of each shift for three weeks – you’ll just be even more confused. Pick one and stick with it; you have to get used to where the boxes are on the pages to quickly fill it out and it takes a few shifts to settle into that.

The report was such a big deal to me that in my new grad nurse residency, I devoted 5 modules to it with sample report sheets and audio examples of me giving report so you can practice filling out a report sheet.

Build rapport with your nursing assistants

Your CNAs are an important part of the nursing team. Please don’t walk on the unit on the first day, guns blazing, ordering people around. This will create a terrible work atmosphere.

I encourage you spend a little time getting to know them before delegating as much as humanly possible. If you can demonstrate that you respect their time and expertise, they will feel valued. When people feel like their role matters, they take more joy and pride in what they’re doing – and it’s better for everyone, patients included, when people are in that state of mind.

So, when you start out  – ask for their opinion on something, ask if you can help with a bed bath… also, just get to know them as a fellow human you’ll be working alongside. I’m not saying you need to be BFF’s, but getting to know someone (like you’d take some time to get to know your patients) can really make a huge difference in how a team functions. If you respect them and what they bring to the table, they are much more likely to do the same for you.

We all desire to be valued and recognized for the work we do – nursing assistants are just the same.

Brush up on the patho of the disease processes you see most

I’m sure a lot of that patho you learned in school probably didn’t hang around. Even if this is your very first job from nursing school, chances are that you learned the complex patho months, if not years, earlier… and since you’ve had to learn quite a bit of new information so that may have gotten lost in the shuffle of things. No worries, let’s just brush up a little bit to re-familiarize yourself.

There should be no shame in your brushing-up game. It doesn’t mean you’re stupid or didn’t really learn it the first time. A lot of this stuff is complex and requires going over it multiple times for it to really settle into your brain. So I encourage you to think about the disease processes you see the most on your unit and looking up the patho behind it. Now, if you’re just starting out – simply ask an experienced nurse on the unit.

Generally speaking, some of the most common things you’ll see on a med-surg floor are:

• Heart failure
• Pneumonia
• Gastrointestinal bleeding
• Renal failure
• Chronic obstructive pulmonary disease (COPD)
• Urinary tract infections (UTI)
• Sepsis
• Pancreatitis
• Deep vein thrombosis (DVT)
• Altered mental status (AMS, often caused by infections!)
• Bowel obstruction
• Patients needing a general cardiac work-up for various reasons

If you can refresh yourself on these, you’ll be able to educate your patients better and troubleshoot common complications.

Get your time management routine down

Time management is tough to learn in school. Rarely are you given a full patient assignment, and even if you are, it’s often not for a full shift. Therefore, settling into a time management routine is a steep learning curve. Please know that this is 100% normal and if you’re struggling to get your tasks completed on time, that’s normal!

Please key into how your preceptor is managing their time and ordering his or her steps; particularly when patients are completely stable and it’s a normal day. School talks a lot about emergencies and urgent situations, but rarely are they diving into how to successfully complete a plethora of tasks when everyone is doing just fine.

Know you’ll be inefficient at the beginning – much like you were inefficient when you first learned how to use a smartphone. But keep showing up, learning where you could have ordered your steps a bit differently, what ways you can do something more efficiently, what works, what doesn’t, and you’ll begin to settle into a new normal.

Med-surg nursing final thoughts

The safest and most successful med-surg nurses are the ones who can admit when they’re wrong or don’t know something, are open to trying new things, hearing feedback, and just trying to do a good job.

You shouldn’t know everything when you start this job – no one does. The sooner you can be comfortable with discussing where you truly are in your learning process, not where you think you should be, the better. That’s where authentic and meaningful learning occurs. So many people think that because they have RN behind their name and landed the job that they’re supposed to know everything… and none of us do, so some people pretend to know and understand everything – and that’s where you really get into trouble.

Learn More

Here are some more resources for new med-surg nurses:

• Types of Nursing Jobs and Where to Find Them
• What Do Med-Surg Nurses Do?
• Nursing Time Management Tips