In this essay, I present my firsthand account of my experience as an African American nursing student in a predominantly nonminority nursing program as well as my perceptions and interactions with fellow students. As an autoethnographer, I sought to answer the following question: What is the African American student nurse’s experience of education in a predominantly nonminority school of nursing and university, and how does that experience affect her as an individual?
Pre-Nursing School: Being “White”
In high school, I was called “white” by the majority of the few African American students in a high school of nearly 500 students in the Northeast. Initially, when they said this to me I was shocked. I had been on the receiving end of racially charged comments by white peers, and now I had to deal with this from my own race and ethnicity, too? I wondered why I could not catch a break. I remained confused but focused on my schoolwork. Since being a freshman, I was in honors classes, those with the maximum rigor in the entire school. It was viewed as if only the elite were in these classes, but I surely did not feel like the elite. My white peers in those classes assumed I came from the ghetto and asked me to teach them Ebonics and about rap music (which I did not listen to). I was isolated in those classes because of such stereotypical comments and the competition to be number one of the entire graduating class, but mainly because I was the only African American student in such classes. The comments from my African American peers only intensified as I was enrolled in both cosmetology in vocational school and Advanced Placement courses (which could alleviate me from taking college courses, once enrolled).
One of my African American acquaintances, who I thought seemed amicable, approached me purposefully one day in the hall. She looked like she was on a mission to find me as I put my things in my locker. I met her with a kind hello—I did not have many friends in school. I blamed myself for that, being so quiet. She stated loudly with a greeting, “Do you think you are better than us?” I said, totally confused, “Us? Better than who?” She quipped, “You know exactly who I mean, the few blacks in this school.” My face must have looked blank. I just stared at her with curiosity due to the fact that, besides the “white” comments, there was never an extended conversation or association besides my distant friendship with several other minorities. She continued to badger me, “You know you think you are better than us since you are in those special classes. Who do you think you are?” I simply responded, “Nothing.” At the time, my self-esteem was low; I had become tired of my lack of association. She was not buying it. “You know what? It must be true that you are white because you even talk like them,” she said. “Don’t ever think you are better than us. We are just as smart, although we may not be in the AP classes.” Taken aback, I explained, “I never said you weren’t. You should talk to your advisor about enrolling in one of the classes.” Without acknowledging my reply, she stormed away, saying, “Wow, you are white.” As she walked away, I blinked at her and said to the dust trailing behind her, “It is funny because my skin is black like yours.” I went on to finish my day; however, the episode never stopped playing in my head, even after I became a nursing student.
Katie Love, PhD, APRN, BC, AHN-C, wrote about the lived experience of African American nursing students in a predominantly white university in a 2010 article published in the Journal of Transcultural Nursing. One of the themes of her phenomenological study was that of fitting in and “talking white.” She reports about a study participant who had grown up in a predominantly white secondary school and had become accustomed to experiences with white students. African American nursing students who did not have such an experience described some African American students as being “Oreos…Black on the outside and white on the inside.” Such “Oreos” are described as African American students who are black but “act White, socialize, and talk like White people.” One of the participants of the study shared the following observation: “To me it’s kinda a funny thing that it’s such a problem in the Black community that you could not talk in a certain way…but if you start talking slang, then to them you’re trying.”
I could identify with Love’s study as my isolation from peers—from within my own race and from without—began in high school. In high school, I was excluded by white students because of the color of my skin and, at the same time, excluded by my African American peers because of the way I carried myself and spoke. In nursing school, my isolation continued. It would eventually lead to my depression.
Nursing School: Feeling Isolated and Excluded
Fast forward to nursing school. The faculty and advisors began our edification with a talk about the rigor of the courses. I remember a gentleman announcing, “Look around the room. See everyone here? Not all of you will be here in four years. The truth is, nearly half of you may not make it to graduation.” I remember sitting in the warm amphitheater and feeling intimidated by his words. When I looked around, as instructed, I noticed the class was made up of only three African Americans. The largest minority group were of Hispanic background.
The first few semesters were full of straight science courses, which translated into nonstop studying. I spent my days in the library enjoying my books and learning. The days went so fast, when all I did was read and study the day away. In the blink of an eye, the end of the first year arrived. All of the Hispanic students were eliminated either by not meeting academic requirements or by choosing to leave the program. I was afraid that I would be next. My classmates were mostly white students. At times, I felt I did not belong. None of my professors looked like me. The nonminority students studied together and did not invite me, much less speak to me.
I remember our professor addressing the class during our sophomore year. She advised everyone in our small section to avoid driving alone to a distant clinical site and to carpool instead. I looked around the room attempting to make eye contact but did not receive any response. My nonminority peers turned around in their seats and, within minutes, had arranged themselves into two car groups, which left me out. I told myself, “You really thought it would be different, huh?” I laughed to myself and stopped looking for a group. That experience solidified the divide for me.
In 2004, Nancey France, PhD, RN, and her colleagues at Murray State University published a pilot study in Visions: The Journal of Rogerian Nursing Science that examined the lived experiences of black nursing students and found many reported feeling isolated and discounted. One of the themes of the data was “You’re just shoved to the corner.” One African American student nurse clarified, “You may get one or two that wants to include you…You may go up to them, you’ll risk to say ‘are you going to study?’ If you think that you know them and everything’s o.k., you’ll say, ‘are you all going to have a study group this weekend?’ And they’ll say ‘yeh’. But, when the time comes…you can’t get in.” Another student reported, “I’m the only black, in all my classes I’ve been the only black. It’s hard because…you got to prove yourself. If you don’t do as well as the other students they just single you out. That’s why I have to strive to do the best I can.”
Black students also reported feeling they were only admitted to schools of nursing to meet a quota. They described the increased pressure exerted on them when minority attrition rates were high in their class. As a result, they experienced emotions such as self-doubt, fear, lack of confidence, and diminished self-esteem before attending class. Many students reported these feelings pushed them “even harder to prove they could be successful.” There seemed to be a consensus that there was an unspoken expectation of African American students to fail, which propelled these students to greater levels of determination to prove that “they were as smart as anyone else.”
Moving Up: The Benefits of Exclusion
During my third semester in nursing school, I became tired of sitting in the back of the classroom. What had once seemed comfortable became an annoyance to me. The students who supposedly knew all the answers sat in the front, always the first ones to raise their hands. However, their answers were the same as mine—always. They weren’t any better than I was. I decided to beat the caste system within my own classroom. I felt my sitting in the back row was perhaps contributing to my isolation and depression that had begun to develop. Humans are not meant to be excluded—we need contact. As a result, I started moving forward, slowly but purposefully, to avoid and overcome my feelings of exclusion.
I remember deciding I would not allow myself to sit in the back anymore. I felt like Rosa Parks as I migrated up to the middle rows of the classroom. I began to raise my hand more. I found that studying alone was beneficial to me, as I knew the full answers to questions that other students merely answered in a general way. As a result, I started raising my hand and answered insightfully each time.
I wasn’t sure of myself until my anatomy and physiology professor approached me and asked if I wanted to become a physician. He tried to convince me to enter the premedical program. I was flattered and taken aback, but I knew it was not what I wanted. I had fallen in love with the few nursing courses we were allowed to take. I could not betray my passion for nursing and really “being” with the people. However, he had not approached anyone else in the class with this offer.
It was after that discussion that I moved up and became the snob who raised her hand to answer every question, at every opportunity. It was not until then that I had my first contact with nonminority students, other than a glance. They soon began asking how well I did on my exams. When interrogated, I replied without emotion, saying I did “okay” when I knew I got an A. They soon lost interest in me again. They did not know that their exclusion of me in their study groups was paying off greatly for me. I had become an independent and successful learner.
As the years progressed, I think they began to suspect I was doing better than just “okay” as I began to earn scholarships and recognition from my professors in class. It was unwanted attention for me because I wanted to keep my head low. What began as a business venture to simply gain a skill that would sustain me as an adult turned into a love for the profession of nursing. I had not expected that—it just happened. As my love grew, I began to excel. As I excelled, I felt the isolation increase. I had become used to it; it didn’t really bother me on the surface. It seemed other students were in school to make lifelong friends and to have a good time. I was in nursing school solely to earn my degree, focusing intently and singularly on my studies; so, most nursing students tended to avoid most nursing students avoided me.
I soon began to wonder if I had isolated myself, but then I noticed in my junior year that professors began to assign more group assignments. In those voluntary group assignments, I observed minority students chose to work together in the same groups, while nonminority students chose to work together in their own groups. I wondered if the professors noticed the same thing I did. It went on like this until the end of the nursing program.
A 2015 integrative review published in Nursing Education Perspectives reaffirmed that there are several studies where African American nursing students reported feeling “voiceless, not part of the important conversations, left outside of the cliques, alienated and insignificant.” Many minority students coped with these conditions by forming their own network among other minorities and “sticking together.” Additionally, Love noted in her study that African American students familiar with “being left out” from high school experience were better able to accept exclusion and move beyond the experience.
All that studying and exclusion seemed to work better for me. It worked out because I graduated. During graduation, I knew a select few would earn special acknowledgement for their achievements. I was sure it would not be me. I was so focused on getting out of there. I had the chance to extern on a unit in a teaching hospital where nonminority staff embraced me as if I was family. I just wanted out of nursing school. At the end of four years, it felt like prison only being able to talk to and connect with six minorities who made it to the end of the program. Now, I was free to explore the world as an adult with a real job—not just a student building up debt.
These were my thoughts as I was called up to shake hands with all of my professors. I was so focused on receiving my degree that the moment when they called my name seemed only a second. When they began to announce the special recognition awards for academic and clinical excellence, I kept looking back at my family and realized I was one of the few students wearing a purple tassel, which meant we were part of a special group: the Honor Society of Nursing, Sigma Theta Tau. We had high GPAs.
Then I heard one of my professors say my name. I looked around and those around me whispered, “That’s you! Get up! They called you!” I had earned the award for clinical excellence. I was speechless and nearly stumbled up to the stage. I thought my professors were not interested in me, but they had nominated me for this award (and I assume they voted that I receive it). I was flabbergasted but filled with pride because I—the quiet African American student nurse—had earned this great honor. I thought I had not deserved it, because there were so many things I did not yet know, and I knew I was not the perfect student. I critiqued myself for those few senseless Bs I had earned. It was not until I returned to my seat the second time that I realized maybe I did deserve this award. Just maybe, I had worked hard enough in that I enjoyed putting the entire patient picture together—staying in their rooms, discussing how they felt about their illnesses while taking it all in, and figuring out how I could use my knowledge to prevent one less complication. I was more than a student nurse in those moments with my patients; I assumed the role of nurse and took such opportunities with the utmost seriousness. I remember a great exhalation as everyone threw their caps to the roof of the auditorium. I was deserving.
Soon after graduation, I passed my licensing exam on the first try and began working on a medical-surgical floor at a teaching hospital. My work was challenging and kept my attention, but I soon began to crave schooling. I decided to enroll in an online program. The main reason for doing so was so no one could see my face and perhaps I could fit in for once. And I did. I felt since no one could see the color of my skin or the youth of my face there would be no divisions. It proved true. I enjoyed my online schooling and soon pursued a doctorate program online after completing my master’s in nursing education.
In a 1998 study published in the Journal of Nursing Education, author Mary Lee Kirkland, EdD, RN, concluded that the most successful coping strategies of female African American nursing students are active coping and social support. She explains that “although they may have faced times of discouragement or despair, they did not waver in their pursuit of their goals. They relied on their inner strength to take the action needed to conquer their stressors and move on successfully.” I had a support system of my spirituality, my family at home, and my friends of the same faith that kept me strong. They probably were unaware how they were the one thread that held me together through emotional turmoil and numbness.
Enlightenment Upon a Return to the University: Six Years Postgraduation
Aside from the anatomy and physiology professor, who was from the biology school, I was never sure how the true nursing faculty viewed me. It was not until I returned six years later as a clinical nurse specialist to become a mentor for nursing students like I had been—of the minority. I was also pursuing a scholarship for my doctoral education with a focus on nursing education.
When I met with one of the professors, I was sure she had forgotten me by the e-mail she had sent back when I asked for a letter of reference and to meet to discuss a mentorship program for minority nursing students. However, when I walked in the door in my professional attire, she told me, “Wow, I remember you. I wasn’t completely sure in your e-mail, but now I know who you are exactly…You were always so bright. I knew it then, and look at you now and all you have accomplished. You have your master’s and are a clinical nurse specialist….[Another professor] and I are rooting for you to get this scholarship.” Our conversation ran long before a student showed up for her advisement. The professor told me warmly, “Keep in touch. We are so proud of what you will become and have become already!” She had written my letter of recommendation. However, the recognition she provided in those moments proved to me I did not know myself those years as well as I did right then.
I had not been invisible, after all, and the award I received upon graduation was not for show, but because my professors saw such great potential in me. I had become visible to myself and the world. My confidence soared as I left the campus. I had driven in, but I seemed to fly home, alongside the clouds.
In part one of this two-part series, we illustrated the types of prejudice and stereotypes that male nurses can often face. What happens, though, when male nurses experience it? What can or should they do?
What to Say
If confronted by someone who believes that men don’t belong in nursing, you should be professional and take the opportunity to educate them. “I would tell them to check the data,” says Donnell Carter, MBA, MS, CRNA, clinical staff nurse anesthetist at Saint Vincent’s Hospital in Worcester, Massachusetts. “Many men are turning to nursing because it is a secure and rewarding profession with plenty of opportunities for personal growth. Nurse anesthetists, in particular, practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.”
Tell them to walk the walk. “I would ask them to join me for 12 hours and see if they could do what I do. Walk a mile in my clogs,” says Jeremy Scott, MSN, RN, CCRN, a resource pool nurse at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania.
Look into history. Kody Colombraro, LPN, EMT-B, a hospice care consultant at Regency Hospital in Augusta, Georgia, suggests that you give them a history lesson. “If it hadn’t been for the crusades, males would still be the dominate sex in nursing. The first nurses were the Knights of Hospitaller, also known as the Order of St. John. They were believed to have been the medical caregivers to the Knights of Templar. It wasn’t until Templar numbers decreased that they were militarized and sent to battle.” When that happened, women began filling the need for nurses.
Ask Why? Les Rodriguez, MSN, MPH, RN, ACNS-BC, APRN, clinical nurse specialist/clinical education specialist pain management for Methodist Richardson Medical Center in Richardson, Texas asks them why they think that way. “Men are just as capable of being nursing as women are in being physicians. Men are just as capable at being nurturing, compassionate, empathetic, and caring as women are,” he says. “We have females in the battlefield, flying planes, and running corporations. Why can’t and shouldn’t a man be a nurse?”
Enlighten Them. “When you consider the aging and declining health in America, I firmly believe that we will need every man and woman who aspires to to be a registered nurse,” says Dave Hanson, MSN, RN, ACNS-BC, NEA-BC, regional director of nursing practice, education, and professional development at Providence Health & Services Southern California in Burbank, California. “According to the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, men provide a unique perspective and set of skills that are important to the profession and society. The IOM report also noted that the nursing profession needs more diversity—in gender as well as ethnicity.”
What Action to Take
If you’re a male nurse and dealing with stereotypes, prejudice, and/or discrimination, there are actions you can take. “Discrimination is a big problem. If any nurse is being discriminated against, he or she should contact human resources, their union representative, and, if needed, a lawyer,” advises Basler.
“The first stop should be their nurse manager—unless that is an issue. Then, human resources—unless that is an issue, with the next stop being an attorney on the way to a new job,” says Scott. “I personally would not deal with nonsense.”
Regarding stereotypes, they still exist, and, for some people, always will. But male nurses can do their part to help eliminate them. “One way to dispel stereotypes is to understand that it’s typical to have variations within any group, including the nursing profession. Recognizing and respecting the diversity that exists within the nursing workforce is what will strengthen and grow our profession,” explains Hanson. “It’s essential for the larger community of registered nurses to stand together to advocate for ongoing education, research, policy, and dissemination of information about men’s health issues and men in nursing.”
And be all that you can be. “Do an outstanding job and go above and beyond for their patients and team members,” says Carter. “I would also recommend seeking leadership, teaching or mentoring experiences to help change public perceptions. It’s important for men to actively seek to change the face of nursing by highlighting their diversity.”
Carter continues: “My career has rewarded me with many opportunities. The face of nursing has truly changed over the last two decades. I expect that more men will decide to pursue a career in nursing in the future.”
Concentrate on the job at hand. “Just keep your nose to the grindstone and surpass all negativity,” says Robert Whigham, RN, a staff nurse at Doctors Hospital in Augusta, Georgia. “Watch your life flourish.”
“You decided to join a profession that has been dominated by women for generations,” says Jonathan S. Basler, RN, a clinical nurse at West Front Primary Care in Traverse City, Michigan. “Choose your mentors wisely and be the best nurse you can be. Let your knowledge, skills, and compassion define you as a nurse—and not your gender.”
Many people experience some kind of discrimination, stereotyping, or even prejudice against them at some point in their lives because of their race, sex, sexual orientation—and even sometimes because of their jobs.
While more and more men are entering the nursing field, it’s still a profession that is primarily comprised of women. So we asked a number of male nurses what they’ve experienced, how they’ve dealt with it, and their advice for other nurses who may experience something similar.
In this article, we begin with what kinds of stereotypes they’ve experienced.
Are You the Doctor?
Nearly every male nurse we interviewed said that he had, at least at one time, been mistaken for a doctor. They all, though, handle it in their own ways.
“I have walked into an exam room where a patient is waiting, and before I had a chance to introduce myself, they said, ‘I thought I was seeing Dr. Weber.’ I just smile and say, ‘You are seeing Dr. Weber. You just get to see me first. I’m Jonathan. I’m a nurse, and I’m going to check your INR before he comes in,’” explains Jonathan S. Basler, RN, a clinical nurse at West Front Primary Care in Traverse City, Michigan. “Then they usually say, ‘You’re not as pretty as his old nurse.’ When I worked in nursing homes, it was common for me to hear, ‘Thanks, Doc!’ as I was leaving a room—and it didn’t matter how many times I introduced myself as their nurse.”
Keynan Hobbs, MSN, RN, PMHCNS-BC, a clinical nurse on the PTSD Clinical Team at VA San Diego Healthcare in California, says that he is mistaken for a doctor all the time and was even back in nursing school. “It happened even more when I moved into an advanced-practice nursing role and wore a white lab coat every day,” he says. Because he works in psychotherapy now, he is often called “doctor.” His response is, “I’m not a doctor; I’m an advanced-practice nurse, and you can call me Keynan or Mr. Hobbs.” Although he doesn’t find this now in psychotherapy, he says that when working in a hospital, “People would look right past me when I told them I was a nurse because some see nurses as less powerful in that setting.”
Sometimes, nurses use humor. Jeremy Scott, MSN, RN, CCRN, a resource pool nurse at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania, says that patients will sometimes be on the phone, and when he walks into a room they say to the person they’re talking to, “My doctor is here. I have to go.” He then tells them that he is their nurse. “People have asked, ‘When will you go back to become a doctor?’ and I jokingly tell them, ‘I’m not interested in all those loans. I enjoy being a nurse.’”
It’s Not You, It’s Me
Sometimes, patients or their family members don’t want a male nurse—simply because he’s a guy.
“I’ve experienced stereotyping as a male nurse. I’ve had patients tell me they don’t want me to be their nurse. I’ve been called gay. I’ve been told by family members that they don’t want me to care for their loved one,” says Carl A. Brown, RN, BSN, director of patient care services for BrightStar Care of Western Riverside County in Sun City, California. “As a nurse—but especially as a male nurse—you need to have a strong outside to let those comments bounce off. But you also need to have a warm heart for those who hold the prejudices. I think it is important for people to know that my gender does not prevent me from providing quality care to each of my clients.”
There are instances in which patients will request a female nurse because of religious reasons. “I respect patients’ wishes because they are in control of the management of their health, so I simply switch assignments. I’m never offended by this,” says Donnell Carter, MBA, MS, CRNA, a clinical staff nurse anesthetist for Northstar Anesthesia at Saint Vincent’s Hospital in Worcester, Massachusetts.
Robert Whigham, RN, a staff nurse at Doctors Hospital in Augusta, Georgia says that it’s common for patients to have preconceived notions about his level of compassion because he is a guy. He’s found that patients in maternity wards and pediatrics may ask for someone else. “They are sometimes uncomfortable with a male nurse helping them,” he says.
In the psychological setting, Hobbs says that “someone who has experienced sexual trauma and doesn’t feel comfortable talking to a man about it” may ask for a female therapist. If they later want to talk with a male, he says that he will be available for them.
Specific Stereotypes for Male Nurses
Les Rodriguez, MSN, MPH, RN, ACNS-BC, APRN, clinical nurse specialist/clinical education specialist pain management at Methodist Richardson Medical Center in Richardson, Texas, says that while in his more than 30-year career as a nurse he hasn’t experienced discrimination, he has come across stereotypes that people think regarding male nurses. They are: all male nurses are gay, men only get into nursing so they can see women naked, men who become nurses are failed doctors, and men go into nursing because it’s easy.
Rodriguez disputes all of them: “In my experience, the number of male nurses who identify as gay is not greater than that reported in the general population. [Re: Seeing women naked] That is an expensive and long, drawn out way just to see what you could see in magazines or strip bars. [Re: Failed doctors] This has to do with relegating the physician to a higher order of professional…Yes, there are some individuals who were in medical school and didn’t survive the program for various reasons, and so they took their academic credits and directed them towards nursing. That does not make them ‘failed doctors.’ It makes them very knowledgeable nurses. [Re: It’s easy] That nursing is easy is a major myth. You are required to learn a lot of detailed information in a very short time…Nursing is not an easy profession, and many males that I have encountered go into nursing because they have a caring disposition.”
Now that we’ve outlined what some of the prejudices and/or stereotypes are regarding male nurses, the next step is to educate them on what they can do. Stay tuned for part two of our series next week where we’ll explore the actions that male nurses can take.
Women represent nearly 80% of the healthcare workforce, and they represent 77% of hospital employees. Also, 26% of hospital and health system CEOs were women in 2014. Statistics show the number of women in healthcare is rising, but there are still challenges. One of the most widely talked about challenge is gender inequality, including the lack of women in leadership positions. While gender inequality is important, this issue is not why women in healthcare are an endangered species.
Women in the healthcare industry are just as likely (if not more) to suffer from anxiety, stress, depression and other mental and emotional issues. Like most healthcare workers, women who are physicians, registered nurses, home health aides and more enter the field with a passion to help others. But if you fall into these categories, how many times have you neglected your own needs? Shouldn’t you treat yourself with the same care as a patient?
While the term endangered is normally used in reference to animals, you’re surrounded by just as many threats as a leopard in the wild. For decades, women in healthcare have suffered from stress, fatigue, strain due to schedule, insufficiency in internal training, and injuries from physical tasks. According to the American Foundation for Suicide Prevention, female physicians die by suicide at a 400 percent higher rate than women in other professions. One article posed the question “who takes care of the caregivers?”
The answer is YOU!
There are some issues in healthcare that is a work in process, but you have the power to positively influence your well-being today. Your patients need you. Your family needs you. And, you need you. So, treat yourself with proper rest, prayer, stress management techniques, supportive relationships, and be the first thing on your to-do list by adhering to your discovery checklist.
Nursing school is difficult, no doubt, but it pales in comparison to the first year working as a nurse. New nurses face many obstacles they may not have even fathomed while in school. Whether you landed a position in your dream unit or had difficulty securing the first job, the first year out for any nurse is challenging.
Once out of school, many wonder if their first job will be anything like their professors taught. Unfortunately, it’s not, but there are ways to cope with learning the ropes of nursing. A nurse of just over one year, Kelsea Bice, BSN, RN, an emergency room staff nurse at MD Anderson Cancer Center in Houston, Texas, realized her first-year nurse training was much different than school. “Most came from preceptor roles. I found it extremely difficult to rationalize my book training with the experience of my preceptors and my own thoughts,” she recalls. “It was very overwhelming at times.” Although it can be overwhelming, here are some key points for newbie nurses to remember when transitioning from student nurse to nurse.
1. Remember that School and NCLEX Do Not Reflect the Real World
Many new graduates struggle with the sheltered environment of school and the hypothetical world of NCLEX when they are in their first job working with real patients. The ultimate goal of nursing school is to teach one how to pass NCLEX. A nurse’s first year on the job teaches the individual how to become a nurse. The two realms massively collide with the first job after school. “The most difficult part of the first year is taking critical thinking from a theoretical/hypothetical situation to a real person in a real bed in front of you,” states Bice.
As a student, the first-year nurse is not exposed to all of the internal policies and systems of a clinical facility. In a new environment, reports may be conducted differently from the ways one was previously exposed to, some common procedures may be completed in an unfamiliar manner, and, when a patient is crashing in a real-life setting, it isn’t always “textbook” like NCLEX. These nuances can be hard for new graduates to grasp without their own experiences to pull from. Once out of school, new nurses soon realize that patient ratios will often be higher than they were while in school. Nurses, especially new nurses, have to really work on honing their time-management skills. When asked how nursing schools can better prepare students, Arthandreale Nicholas, BSN, RN, a nurse at Harris Health Outpatient Medicine Clinic in Houston, Texas, says, “[M]ore clinical hours with realistic nurse-to-patient ratio staffing [are needed] so new nurses can be prepared to have more patients and develop time-management skills.” As any experienced nurse knows, time-management skills will improve with time.
Prioritization also serves a vital role in a nurse’s first year on the job. Prioritization and time management go hand-in-hand; once one is mastered, the other will become easier and vice versa. Nicholas, a nurse of five years, recalls her most valuable lesson in her first year was prioritization of duties. “Make sure to see sickest patients first and get meds passed ASAP,” she suggests. New nurses may not realize how long 12-hour shifts really are—or that they may not get the desired shift they want to work directly out of school. Typical 12-hour shifts turn out to be longer when you factor in commute times, codes at shift change, or a lengthy report. In addition, nursing schools don’t prepare students for difficulty finding their first job in an oversaturated market. Nicholas experienced long days and an undesirable shift firsthand; her commute to her first job, a neuro step-down unit, was 60 miles each way and she worked a “swingshift,” meaning she alternated between night and day shifts. “I only stayed at my first job for four months. The schedule with the commute made me very discouraged, so I actually went months without working until a local hospital gave me a chance,” says Nicholas. New nurses are ill-prepared for these realities since the average nursing school does not typically have students complete a full 12-hour clinical day. In addition, the clinical sites are typically in close proximity to the school.
2. Respect Your Elders
We’ve all heard the phrase “Nurses Eat Their Young” (or “N.E.T.Y.”) when referring to the way some seasoned nurses communicate with newer nurses. Sometimes, there are personality conflicts between people, but most of the time seasoned nurses are just frustrated with the newer generation thinking they know more than they actually do directly out of school. As the saying goes, “You don’t know what you don’t know.” Seasoned nurses on the unit have a wealth of information to share with you—just be willing to listen.
Bice has her own take on the relationship between newer and more experienced nurses: “Older or ‘more experienced’ nurses say new nurses are coming out of school really cocky or with bad attitudes, but I truly think that’s just the generation gap in the workforce showing through.” Bice believes new nurses can thrive in their first year with more encouragement from seasoned nurses. “I think if new nurses are nurtured through their orientation and supported and offered a safe environment to ask questions, make mistakes, and figure it out, they could be successful on any unit,” she adds.
Newer nurses should also understand that there are multiple ways to carry out nursing duties. Their preceptors may have a different way of doing certain asks. Not all nursing tasks are textbook like they were in school, and this may be a hard concept to grasp when just starting out. Be willing to understand why particular individuals carry out their nursing responsibilities the way they do. And if you don’t like it, put your own spin on it later. Be open to others’ opinions when you first start out—you may realize you have learned something you may not have known otherwise. Take it all as a learning experience.
3. Don’t Cause Waves
One of the quickest ways to become the unpopular nurse on the unit is to act like a know-it-all. No one cares that you had a 3.9 GPA in school or that you passed the NCLEX with 75 questions. All anyone—including colleagues, patients, and family members—really cares about is how you can safely and effectively deliver care to patients. Remember, the first job is to learn how to become a real nurse.
Another way to cause waves during the first year of nursing is to actively complain about your chosen profession. The story plays out time and time again—a new grad comes into the unit and continuously vocalizes how much he or she hates bedside nursing and declares plans to be out of there in one year—on to NP or CRNA school. Doing this usually causes a deep divide between you and other seasoned nurses on the unit. This may be where some of the N.E.T.Y. comes into play.
Newer nurses may feel isolated due to their inexperience, but it’s imperative to ask for help from others when needed. Nursing involves teamwork. In addition, starting a new job and attempting to be a martyr by making fellow coworkers look bad only actually makes you look bad in the long run. One day, you will be on the other end and won’t appreciate the lack of compassion. Everybody makes mistakes, and you don’t want to be thrown under the bus because of one. Learn to speak to your colleagues when a problem arises; it could uncover a learning experience for both of you.
4. Continue Your Education
Just because you have finished nursing school and passed your boards doesn’t mean your education should cease. The real education has actually just begun. Continuing education doesn’t mean you immediately go back to school for an advanced degree; it means continuing to learn in your new role. Jonanna Bryant, MSN, MS, RN, a veteran nurse of 24 years, who is currently working on her doctorate, wholeheartedly agrees. “Learning doesn’t stop after one leaves school, and you don’t have to return to school in order to learn,” she says. As a new nurse, you should be constantly looking up medications, medical terms, and diagnoses that you don’t know. It’s uncomfortable being asked a question for which you don’t know the answer. Not knowing the answers should bother you to the point that you want to seek additional knowledge.
It’s imperative that you continue to educate yourself in your chosen specialty—meaning that if you work in the ER, brush up on triage or work towards your trauma certification. Get your Basic Life Support and Advanced Cardiac Life Support certifications. Read nursing journals, re-read your nursing textbooks, and become involved in professional nursing organizations—anything that will enhance your knowledge base. The education of a nurse never stops.
In addition to learning job-specific skills, learn more about the roles of other health care professionals. Learn the role of a respiratory therapist, physical therapist, and radiation tech—these are all professionals you will work with on a daily basis. Education provides opportunities for you to grow not only as a nurse, but also as a person. Enhancing yourself through education makes you a better nurse and allows you to educate your patients, their family members, and your colleagues.
If you do eventually decide to go back to school for an advanced degree, make sure you master your role in your current position before doing so. Regardless of what some may say, an experienced nurse has an advantage when heading into graduate school. Concepts covered in grad school can be easily grasped with the experience one gains from working as a nurse.
5. Find a Mentor
Many nurses, if not all, may feel they were not adequately prepared for the real world even after finishing school and passing the NCLEX. The type of treatment new nurses receive in their first year can negatively or positively affect their overall career trajectory. This leaves a new nurse either loving the profession and wanting to stay in for the long haul or loathing the profession and trying to leave altogether.
“The first year was hard,” says Nicholas. “I honestly almost broke and thought about other career paths. I’m thankful for the good shifts and grateful patients who encouraged me to keep going.”
Potential challenges one may face in nursing should be discussed and support should be given to newer nurses, both in school before they graduate and on the job. Bice believes having more open, honest discussions with preceptors and other experienced nurses on the job would be beneficial. “Debriefing after incidents, like ‘what could I have done better?’ [and] ‘what will I do differently next time?’ This way, gaps in learning are realized and bridged,” she says.
New nurses should not only be oriented to their new career, but also mentored by seasoned nurses. A mentor serves as an experienced and trusted adviser. Mentorship should be a part of orientation for all nurses new to the profession. Bryant, a nurse consultant for the Centers for Medicare and Medicaid Services in Philadelphia, Pennsylvania, also believes in new nurses having a preceptor or mentor for the first year, “…someone who they will follow and be able to ask questions and talk to regarding concerns with their new job,” she says.
The first year of nursing is tough, but manageable with the right mindset. Bice advises the newer generation of nurses starting out to “chill out and listen,” which is in line with Bryant’s recommendations for the first year: “Pace yourself, be thorough, and communicate.” Nicholas wishes she could have told her first-year self to be “more confident” and to not be afraid to question orders she was unsure about. Use their advice to successfully integrate into your new role. Soon enough, you’ll be a seasoned nurse and will be able to give tips to the newbies on your unit.
Nurse bullying is a big problem in the profession, but it’s under reported and not addressed as effectively as possible. And the reason isn’t as simple as nurses not wanting to speak up.
Sometimes nurses aren’t even sure the horrible behavior they are being subject to is actually bullying, says Dr. Renee Thompson, DNP, RN, CMSRN, and CEO and president of RT Connections, LLC, and author of “Do No Harm” Applies to Nurses, Too!,.
Bullying behavior can be quite obvious, but it’s just as often something so subtle the target isn’t even sure if the actions are intended. “Bullies will test the waters,” she says. “They will do something and see the reaction they get. If they are resisted, they will usually, but not always, stop it.” But if the behavior isn’t addressed immediately, the bully takes on power and the behavior can escalate.
What are some things to watch out for?
True nurse bullying behaviors and unintended coincidences can be separated by the pattern and the repetition you will see over time.
The most obvious, and for some nurses easiest to deal with, bullying is the in-your-face colleague who is yelling at you and insulting you. There’s no doubt what’s going on there.
But other things are much harder to really pin down. Dr. Thompson recalls hearing a story from a nurse who won an award and soon found herself with the most acute patients and more cases than any other nurses on the floor during her shifts. The nurse wasn’t sure if she just had a bad luck of the draw, but then she overheard a charge nurse indicating that it was on purpose to bring her down a few notches from her award. Startled, the nurse identified what was really happening.
Other times, nurses create situations to have other nurses fail. Maybe during hand off you weren’t given all the information you needed. “They set you up to make a mistake and then write you up for it,” says Dr. Thompson.
And what about the times when all the nurses wear the same jacket or they all order out lunch together and exclude one person? Or if a few nurses gossip at work and spread rumors? All these behaviors seem petty, but they really happen at some workplaces.
If you have ever seen or experienced these behaviors, Dr. Thompson says it’s a good idea to track what you see. Carry a small notebook and jot things down over a couple of weeks. “You are looking for a pattern,” she says, “not a one-time incident.” Even if you end up doing nothing with the information, Dr. Thompson says the very act of documenting can help you because it can help you establish a clear pattern of bullying. It can be a relief to know it’s not just your imagination.
Then you can choose a few options. You can confront the person in a respectful manner that’s supported with facts (which you now have thanks to that handy notebook!). You can say something like, “I noticed this is the fifth time in a row when you were in charge that I got all the patients with the highest acuity. Can you help me to understand why that is?”
If you aren’t comfortable going to your direct supervisor, you can consider going to your supervisor’s supervisor. You can also approach human resources, says Dr. Thompson. Check your company’s policy on destructive behaviors so you can present a clear case on what specific behaviors have been violated.
And, of course, if you can relate what is happening to how it impacts patient safety or patient care, you have a greater chance of someone doing something about it, says Dr. Thompson. If you went to a charge nurse at 2 am and asked about a patient in crisis and were told to handle it yourself, you have a clear example of how the actions are impacting patient care.
And Dr. Thompson doesn’t wear rose-colored glasses when it comes to nurse bullying. If your boss is best friends with the VP of human resources or with everyone in her line of command, you might want to just leave. “Get out,” says Dr. Thompson. “It’s just not worth it and you can go find a better place. You deserve to work in a great place.”