Every nurse will experience that first day on the job and all the emotions that go with it. “This has happened to me a dozen times since I graduated from my nursing school. The first day on a job is the most memorable experience in my life,” says Mary Wiske, a retired community health nurse who has experienced several first days at jobs throughout her 25-year nursing career.
No matter whether you’re a new graduate or an experienced nurse, the first day at a new job or new location can be exciting, stressful, or overwhelming. There is so much to learn in addition to the duties or responsibility related to the job. If you are a new graduate, congratulations on your first job! This is your chance to begin your career in health care.
Here are four steps that will help you prepare for your first day.
1. Learn all you can about your new employer.
Read through any contracts, induction packs, or emails you have received. These will have important information about your employment, responsibilities, and what you may need to bring with you when you start. When you are familiar with your job description, you will be able to work more safely and efficiently.
2. Plan the route you will take to work as well as some alternate routes.
Find a map, get directions. Incorporate contingency time for bad traffic, public transport delays, or getting lost. If you are driving, remember to find out where you can park.
3. Get yourself ready – pens, a notebook, and a high-quality stethoscope.
Look for comfortable and durable scrubs that make you look professional. You should also plan to wear comfortable shoes that offer strong arch support and a roomy toe box, in addition to heels that do not pinch or slip and a no-slip sole.
4. Take care of yourself.
Be calm and relax. Remember to go to bed early the night before and have breakfast before you go to work. Give yourself plenty of time to get to work so you do not show up late.
Finally, you are here–the first day on the job. It is normal to feel nervous or excited. It is wise to remain calm and carry yourself with confidence; that is the key to this. Keep a positive attitude and an open mind. Remember to take an active role in your orientation and do not be afraid to ask questions. Make an effort to learn new things and learn how to do something a new way. All you can do is try your best and do your job the best way you know how.
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.
No one can say nursing is a stagnant profession. Even freshly minted grads can feel they are scrambling to keep up with new procedures, technologies, treatments, and processes. If you’re a nurse, you might start to wonder what skills you will need to succeed and stay current in the coming years.
There are a few qualities shared by all successful nurses. Being an excellent multitasker, having empathy, and being nearly obsessed with details never failed a nurse. No matter what your specialty, your location, or your aspirations, experts agree that a few skills in your wheelhouse will not only advance your career, but also help you satisfy your goals of being the best nurse for your patients.
“The first thing you have to have if you want to be the best nurse possible is you have to really want to do it,” says Leigh Goldstein, assistant professor of clinical nursing at the University of Texas at Austin School of Nursing. “You really have to want to be a nurse and not just bring people pills and plump pillows. To get there, you have to put in the hours and put in the study. There’s that little thing in you that tells you, ‘This is it,’” says Goldstein. “It makes learning all the other skills easier.”
LaDonna Northington, DNP, RN, BC, professor of nursing and the director of the traditional nursing program at the University of Mississippi Medical Center, agrees that nurses need a passion for the job. “This is not for the faint of heart,” she says.
Looking ahead, here are some of the essential skills nurses will need to meet job demands at any career juncture.
Develop Critical Thinking/Critical Reasoning
The best nurse thinks outside the box. Adapting to changing situations, unique patient presentations, unusual medication combinations, and a rotating team takes awareness. Assessing and evaluating the whole picture by using the critical thinking developed in school and on the job is essential to success.
“Nursing is not like working in a bank,” says Goldstein. “It’s not 9 to 5. It’s always a unique set of circumstances. You have to tailor and adjust the care you deliver based on the picture the patient is giving you.”
According to Northington, nothing in nursing is static. Nurses can’t usually just treat one patient issue—they have to determine how the patient’s diagnosis or disease has affected them across the lifespan, she says. And nurses have to consider not just the best choice for the patient and the best option for the nurse right now, but they also have to consider those things in light of the city they are in, the timing, and the resources they have at hand or that are available to them.
Make Friends with Technology
Nursing moves fast, but technological advances are sometimes even faster. While new nurses might lack years of direct patient experience, they often have essential technological familiarity. “Most nurses are probably aware that the world of electronics has just taken over,” says Barbara Vaughn, RN, BSN, BS, CCM, chief nursing officer of Baylor Medical Center in Carrollton, Texas. “The more senior nurses who didn’t grow up in the technology world tend to struggle more than nurses who grew up with that.”
With apps that allow nurses to determine medication dosages and interactions and websites that allow patients access to electronic health records, technology is an integral part of modern nursing. “Technology is changing how we practice and will change how nurses function in the future,” says Vaughn.The benefits are incredible. Instead of having to make the time-consuming drive into the ER when needed for an emergency, a specialist might now be able to save precious minutes by first examining a patient remotely with the help of monitors and even robotic devices. Nurses will have to adapt to this new way of doing things.
Nurses have to practice with technology to gain a fluent understanding, says Vaughn. Vaughn, who is studying for her PhD, says she didn’t grow up with online training as the norm, so when her new classes required online work, she wasn’t prepared. Realizing this could be a hindrance, Vaughn asked newer nurses about how to do things, and she practiced navigating the system until she became better at it.
Whether you are accessing patient records, navigating online requirements for a class, or learning a new medication scanning program, technology will improve your work day and help you take better care of your patients. In the meantime, Vaughn just recommends playing around with the computer when faced with something new. In her own department, Vaughn recalls some nurses who were especially stressed out about learning the new electronic health records system. With training and practice, they excelled. “They were later identified as superusers for their unit,” says Vaughn with a laugh.
Adapt to the Broader Picture
With all these developments comes new and greater responsibility.
“As an inpatient nurse, you used to worry about the 4 to 6 days when the patient was under your care,” says Vaughn. “Now if you are in a hospital based setting, you are going to be more involved in patient population health.” That means an inpatient nurse not only has to get the whole story of what happened before the patient arrived at the hospital, but also think about working with the care team to give specific instructions for when patients get home that will be practical.
“The more specialized medicine gets, the more fragmented health care becomes,” says Northington. Technology and that broad view can help reign that all in—and nurses need to know how the puzzle pieces fit together and where and how patients are receiving care.
“More patients will be followed in nontraditional health care settings,” says Vaughn. “Our world and the world we know is going to change,” says Vaughn of the health care industry. With more patients being followed by health care centers in easily accessed sites like Walmart and Walgreens, telemedicine is going to become more important to understand and to navigate.
Practice Effective Communication
Thirty years ago, communication about patient care was effective, but certainly not at today’s level, says Northington. “We have to communicate,” she says. “You have to ask, ‘What do you know that I don’t know that can help this patient?’ or ‘Are these therapies contradictory?’ Nurses are in that integral place to facilitate that interprofessional education and communication.”
Good communication isn’t always easy. Beth Boynton, RN, MS, author of Successful Nurse Communication, says the most effective communication is based in speaking up and in listening.
Especially in fast-paced and dynamic health care settings, the underlying interpersonal relationships can have a huge impact on how colleagues communicate and relate to each other. Nurses need to not only recognize the dynamics at play, but also learn how to work within the environment.
“We all think this is easy,” says Boynton, “but we have to recognize this is harder than meets the eye. Be patient with the learning curve.” Nurses might be assertive about speaking up for their patients’ needs, but not for their own, explains Boynton. So, as nurses look to the future, they should be mindful of not only fine-tuning their ability to speak up, but also listening to both patients and colleagues in return without judgment so everyone can work towards the best possible outcome.
Stay Current
“The nurse of the future has to stay committed to learning,” says Northington. “Take what the research is saying and use the best practices. Ask the questions like, ‘Why are we doing it that way?’ and ‘What can I do differently that will produce a better outcome?’”
To be the best nurse, you must stay current in the newest developments. Take the time to learn new procedures, but also recognize where your skills need updating. For example, if you know you’ll need to deal with chest tubes, don’t just assume you’ll know what to do when the time comes. Make an active effort to gain current experience.
Develop Mentoring Relationships
Every nurse needs a mentor. It doesn’t matter what your role is, how many years of experience you have, or even how many months you have been practicing. If you want to advance and learn the intangible skills needed to excel in nursing, you need to actively cultivate a mentoring relationship. Nurse mentors are often found at work, through networks, or within professional organizations.
Refine Your Personal Compass
A little bit of a thick skin will do wonders for any career nurse. “You have to defend your patient from everyone and take care of them,” says Goldstein. That means when a physician makes a call you disagree with or you overhear an unfriendly comment, you need to speak up when it matters and let it roll when it doesn’t.
And some of the personal work nurses have to do isn’t easy, including reflecting on and adjusting for any personal feelings or prejudices they have about patients in an open and honest manner. “We need to be able to take care of people no matter what their circumstances or color or what they did to get here,” says Goldstein. “You can’t treat patients differently. You need to take care of them and not make a judgment.”
Prepare for the Unexpected
You never know what your day will bring, so lots of personal reflection, discussions with others in your profession, and cultivating skills can help you when you are faced with something you’ve never had to deal with before.
“I think whether you are starting out as a new nurse or you are a seasoned nurse, nursing care is constantly changing, and being flexible to those changes is paramount,” says Princess Holt, BSN, RN, a nurse in the invasive cardiology department at Baylor Medical Center in Carrollton, Texas. It’s not easy, she says, to constantly adapt to new approaches and new practices, but nurses need to sharpen their focus. “When I get frustrated, I always go back to put myself in the mindset of my patient I am caring for or of my physician who is making this order or of the family I am taking care of to find new ways of looking at it. It grounds me and helps me understand.”
Developing all the coping skills to deal with job stress is a personal approach that nurses will cultivate as they go.
“New nurses don’t always take care of themselves and the emotional baggage you take with you,” says Goldstein. “You have to incorporate those experiences into a coping strategy that you have to develop on your own. Every nurse needs to figure out what they need to do to handle that.” And if you aren’t able to really learn how to cope, nurses must have the skills to either recognize that some kind of career shift is necessary (maybe even just moving from the ER to postpartum, suggests Goldstein) or to be open to hearing it when others recognize it.
Recognize Your Private Life Impacts Your Career
Nurses have to realize their career choice is 24/7. And while you have to balance your life and leave the hospital behind, you also have to somehow adapt to always being a nurse first. Family picnics can turn into a mini diagnosis session, neighbors might ask you to look at a child’s rash, and your private life can impact your job very directly in a way that won’t happen in other professions. “Nurses are held to a higher standard than the average citizen,” says Goldstein.
Learn Where to Learn
Yes, nurses in school learn the hands-on nursing skills like hand hygiene and infection control, says Goldstein, but, like any nursing skill, mastering them takes time.
Some hospitals have new nurse orientation programs that help new nurses acclimate to the setting, but if you don’t have that option, rely on your own observations, ask questions, and take classes to help get you up to speed. When you’re on the job, watch others to see how they incorporate things like patient safety into their routine interactions with patients. And Holt, who has worked in departments from ER to interventional radiology, says moving around builds skills. “I have seen it all,” she says, “and there is still more to see.”
Put It All Together
When nurses consider all the skills they need to succeed, some are easier to gain than others. “You need to understand what goes on behind all the mechanics,” says Northington. “It’s the knowledge behind the skills you need. They can teach nurses things. Nurses have the rest of their lives to learn things. We need nurses who know how to think, to problem solve, [and] who know when they are in over their heads to call for help. The most dangerous nurse is one who doesn’t ask a question.”
And nurses must keep moving forward and adapting even when the pace seems relentless. “We’ve come a long way,” says Northington. “And in 20 years, nursing won’t look like it looks now. Nursing is one of the best careers because it’s always evolving.”
Congratulations! You’ve managed to graduate from nursing school and pass the NCLEX-RN exam. In addition to that, you have successfully obtained a new-grad RN position after submitting thousands of applications. You’re now gainfully employed and about to embark on your new journey as a registered nurse. You’re very elated and excited to embark on this journey—and you deserve it. You have worked very hard to get here. However, that elation and excitement is short-lived due to the fact that you’re a new registered nurse, and as the saying goes, nurses eat their young.
Bullying towards new nurses isn’t new, and it’s a major problem. There have been many documented occurrences of new-grad bullying, but it’s not alleviating the problem. Unfortunately, this action is accepted and often swept underneath the rug. It’s as if the field of nursing is a sorority and new grads have to undergo a pledging process. It’s not enough that you’ve battled the trenches of nursing school and proven yourself to be a safe and sufficient nurse via passing boards. Now, you have to undergo the brutality and wrath of a negative, experienced nurse who sees you as an annoyance and, at times, a threat.
During my second week of orientation as a registered nurse, I was told by one of the nurse supervisors to watch my back because the experienced nurses could be “vengeful” at times. Her saying this to me was shocking for two reasons: 1) I couldn’t believe she acknowledged the fact that being vengeful towards a fellow nurse was happening on the unit. 2) As a nurse manager, wouldn’t you want to put an end to this behavior happening on your unit in order to maintain peace and order for the sake of patient safety?
Sad to say, this is a game, and new-grad RNs need to know how to play it. I come from a long line of nurses in my family, and when I spoke to them about this situation, they acknowledged that it happens and that I need to take special precautions to protect myself. Here are 10 tips to deal with new-nurse drama that they shared with me:
• Keep a journal and document your days at work. In this journal, keep a record of the date and time of specific events. This way, if you’re ever called into a meeting and/or you’re challenged concerning a situation, you will have a personal record of what was said and done.
• Come to work early and give yourself enough time to get organized. Being organized is key to nursing—and when you’re a new nurse, your coworkers are going to try to find any reason to be negative towards you. Being early and organized helps to alleviate this.
• Maintain a locker with a lock on it. It’s really unfortunate, but your coworkers could be the kind of people who would be “vengeful” and try to steal your items or tamper with your equipment.
• Don’t share any personal information. If you’re talkative like I am, this might be hard to do, but do it. You’re there to work, not to become best friends with anyone. Gaining friendships is fine, but your main priorities should be to protect your patients and yourself.
• Don’t be afraid to speak up and defend yourself. Often, new-grad RNs are made to feel inferior and fear speaking up due to retaliation. Don’t feel that way. You have a right to speak up and defend yourself, especially if you’re being threatened. Legally, you can’t get fired for that. Additionally, you can’t change whatever you tolerate. Therefore, you should acknowledge you deserve respect by standing up for yourself.
• Don’t do anything that is uncomfortable and/or wrong. During my orientation, one of the experienced nurses wanted me to help her distribute medications because she was late. She didn’t want me to look at the Medication Administration Record or any other vital information about the patient. Instead, she wanted to hand me the medications and give them to her patients. I told her no because that was a threat to safe patient care and my license. She became upset and irate with me. Did I care? No. Patient safety and the safety of my license come first. The fear of harming someone or losing my license was greater than the fear of making her upset by denying her request.
• Know your rights. This is important on any job, but new-grad RNs fail to understand their rights because they’re so consumed with learning the rules and regulations of their employed facilities. During your orientation, take the time to speak to Human Resources about your legal rights. It never hurts to know what legal protections you have at your place of employment.
• Mind your business. When you hear other nurses speak badly of a coworker, don’t join them. Walk away and divert your attention to something else. Entertaining the conversation not only makes you look bad, but is also an easy way for you to get trapped into the role of being negative. Besides, what goes around comes around, and if you start talking negatively about someone, you’re going to be the target eventually as well.
• Always take the time to learn something new. This is a great time to be a human sponge. Doing this makes you look like a team player, and it’s a great way to advance in your career. This also makes you too busy to entertain negative thoughts and/or conversations. Learning isn’t limited to learning nursing skills. You should also take the time to learn about the environment in which you work. Learn what’s acceptable and what’s not acceptable. Also, observe and be mindful of the different personality traits of your coworkers. You may like some and you may not. It’s better to learn in order to be prepared.
• Leave work at work. When you come home, it’s time to relax. Nursing is hard work, and you don’t need to worry and stress about it when you’re at home. Whatever happens at work isn’t to be brought into your personal life. Bringing your work home is a sure way to burn yourself out quicker, and it will make you not want to work at all.
Chapter one, part two is about to begin and I am excited. In three weeks I will begin the nurse residency program and take a step closer to my fulfilling my lifelong dream of being a nurse. Last month I received the coveted phone call from a facility I had applied to. After a long telephone interview and two panel interviews that spanned three months, I was offered a position in their nurse residency program.
So, you might be asking, why part two? Well, nursing school was part one—and it was a challenging but rewarding time in my life. And something tells me this new adventure I am about to embark on will be even more so. I haven’t even gone to orientation yet, and drug tests, immunizations, vaccination checks, and a host of other fun human resource activities are keeping me busy until the big day.
For those who do not know what a nurse residency program is, it is a bridge that takes the newly graduated nurse and aids in the transformation into a confident practitioner. The programs vary from state to state, with some being offered by schools of nursing or health care facilities. The length of time can also vary. I have heard of programs being as small as sixteen weeks to larger programs stemming an entire year.
Nurse residency programs are not to be confused with New Grad RN positions, even though both are paid positions. In the New Grad jobs, the nurse is hired on to a particular unit, trained, and expected to become a part of that health care team. Nurse residency programs work similarly to a medical residency where the candidate is moved around to various units, gaining exposure and experience. At the conclusion of the program, the candidate interviews with the unit where there was a potential “right fit” and if all goes as planned, this area becomes their specialty.
I have heard many a conversation about individuals not content where they are working because of various reasons: needed a job right away; family members work there; or nothing else was available. The last thing I want to do is have my very first registered nurse position be a disaster.
The goal of nurse residency programs is to give new nurses the opportunity to be exposed to true nurse life while they are gaining skills. The once-a-week experience from nursing school only goes so far. Many facilities institute these programs to aid in increasing retention rates of the newly trained nurses and allow them the time to develop their competence, communication skills, and become satisfied in their work.
The residency program I am starting lasts sixteen weeks, where you spend at least 4 weeks on at least two units. A new resident can spend up to 8 weeks on a unit and then switch to another one. One unit is acute care and the other is a progressive care unit. Choices range from oncology, orthopedics, and medical-surgical to trauma/neurology, transplant, and cardiac medical-surgical. The program runs like school where novice nurses are matched with preceptors on a regular work schedule and at the end of the shift, the cohort gets together in a post-conference meeting to discuss their day and what they are learning.
Along with learning the units and the facilities’ policies and procedures, new nurses participate in simulations with “live” mannequins that make breathing sounds, bleed, deliver babies, and go into codes. There will be special classes to brush on ECG and pharmacology. And yes, there will be an Evidence-Based Practice project that will have to be completed. Now we’re really sounding like nursing school. I’ll pause to say this: nursing is a lifetime of learning. So if you think you’re done with school after you get your pin and take NCLEX, think again.
At the eleven to twelve week point of the program, the interviews start. This is particularly important because you want to get picked up by the unit you worked on. Once the decision is made, at the fifteen to sixteen week mark the new nurse transitions into their new unit permanently, and the position takes on the expected look of a new graduate position. There is a small graduation of sorts upon completion. Those that have been through the program are not saying much to me about this. I have a feeling it must be truly spectacular because everyone that has gone through the program are still working on their units, still happy and still smiling.
I am eagerly counting down the days. I enjoyed my clinical rotations while in nursing school, so much so that if someone asked me what I wanted to do it was always that unit I happened to be working on. I just loved everything, with the exceptions of oncology, mental health, and pediatrics. Those areas were not at the top of my lists to start my nursing career. So I’ll be spending these last weeks, my vacation, reading, resting and reviewing for this new chapter in my life. Let the adventure continue!
Kimberley Ensor is a new grad RN from SDSU, a published author, and is currently earning her Masters in Nursing with an emphasis in teaching. Visit her blog http://nursekimberley.blogspot.com/ or follow on Twitter @KimEnsorRN
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