With medical errors making national headlines, it is no secret that both training and experience are integral to success as a new nurse. Almost all nurses enter the field with a college degree, but recent research shows that novices make a large percentage of the errors caused by nurses. To avoid mistakes and build a strong foundation for your nursing career, here are three essential skills to prioritize during your first year as a nurse.

1) Developing Strong Instincts for Patient Safety 

Patient safety is one of your primary responsibilities as a nurse. Safe medication administration is an imperative skill to master in your first year. You are the final check between the prescribing provider and the administration of a medication to the patient. If something feels “off”—maybe the dose seems too high based on doses you have given before or the medication doesn’t seem to fit your assessment of the patient—take a timeout and ensure the prescription is accurate. Mistakes happen even in computer-driven processes, whether a decimal point is missed, a duplicate therapy is accidentally prescribed, or a medication is placed in the wrong slot of a medication dispenser. Before giving any medication, ask yourself, “Are all of the correct pieces in place for me to give this medicine right now?”

Learning to safely calculate medication dosages goes far beyond a textbook. Learning tools like UWorld’s Clinical Med Math allow students to practice and perform dosage calculations without the risk of patient harm if they make a mistake. This tool is meant to be a hands-on resource to help students study for drug calculation exams during school, but it also provides fantastic experience to prepare you for real-world nursing.

Another major safety concern is patient falls. Precautions here may include rounding on older patients more frequently or enabling a bed alarm for high-fall risk patients. You should also utilize a mental checklist every time you walk into a patient’s room, such as:

  • Is the floor clear, especially the path to the bathroom?
  • Can the patient reach the call light?
  • Is the bed in the lowest position?

Adding these seemingly small things together develops a strong instinct for safety so when you enter a room, you automatically sense if something is out of place.

2) Forming Clinical Judgment

Your first year as a nurse builds clinical judgment on the foundation of all the knowledge you acquired in school. The ability to recognize potential or current complications that could cause harm is a strong asset to cultivate. This skill involves understanding the pathophysiology behind different disease processes and identifying the signs of improvement or decline. From there, the priority is determining the most important action you can take in the moment to ensure the best outcome for your patient. A textbook cannot teach you how to anticipate patient needs or develop clinical reasoning. You develop clinical judgment by applying your classroom knowledge to the actual patients in front of you.

As you refine your ability to assess patients and interpret clinical data, you reach the point where you can look at a patient and know something is not right—the monitors might look fine, but your assessment and instincts say otherwise. This is an important part of clinical judgment, and it is your job to dig deeper and advocate for your patients. Of course, this critical thinking must occur while also keeping up with scheduled medications at the same time that you are admitting a new patient and discharging another. Developing clinical judgment to juggle these moving pieces takes time.

3) Mastering Time Management

 Time management is another key skill to learn in your first year of nursing. You should be able to look at your whole shift and plan a timeline based on medication schedules, planned procedures, and provider rounds. If all four of your patients have medications due at the same time, how do you organize your time so everyone receives their medications within an appropriate window? Many nurses have their own system of handwritten notes that they keep in their pocket to help organize their day. Asking to see your preceptor’s note system is a great way to get ideas during your clinical rotations in school or during the internship at your new job.

Structuring your day in the most efficient way possible helps develop a “clustered care” mindset where you complete a few tasks together so you don’t leave a room, only to return 15 minutes later. These organizational choices help you accomplish tasks in a seamless, resourceful way. The skill of effectively planning an entire shift comes with time. Do not be afraid to ask questions and learn from other nurses. Pay attention to colleagues who seem particularly organized and solicit their advice—even the smallest tip or trick can make your nursing practice stronger!

Adrianne Duvall, DNP, APRN, CNEcl, FNP-BC

Adrianne Duvall, DNP, APRN, CNEcl, FNP-BC, is the director of nursing strategy & research at UWorld, an education technology company that provides online resources for nursing students for NCLEX prep and medication math skills. Dr. Duvall is also a clinical faculty member at a Texas university. You can reach her at [email protected].

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