Making the Transition From Student to Working RN
Submitted by Ron Simpson, RN
Making the Transition From Nursing School to Working Nurse
Have you ever heard the saying “Nurses Eat Their Young”? Unfortunately, it is all too true in many instances. New Grads or New RN’s are often given into the hands of those who seem to want to spend their time torturing instead of teaching. Why is this so? Power corrupts the ego of some of us. Because some of us have suffered injustices at the hands of others, we feel free to “pay it forward” in order to elevate our ego’s station. The thinking is “I was once on the low rung, now that I have chastised you and put you in your place, you are on a lower rung than I am, and I have elevated myself.” It turns out not to be true, and is more personally damaging than we can know, but at the time it seems so.
This dysfunction is prevalent in many professions, not just nursing. It is all about the ego and the supposed teacher’s self-esteem. The beginner or student is seen as the lowest form of life in the context of the working environment. This dysfunction just stands out more in a profession that is generally perceived as caring and compassionate because that compassion and empathy are not extended to the new nurse in many cases. There is also a deeper psychology. There are those who perceive themselves deep down as poor examples of what the profession of nursing requires of them. These are the “wing clippers.” They clip wings because they themselves cannot fly and want to bring others down to their level so that their inadequacies are assuaged. The new nurse or student is the most vulnerable to the attack and give the greatest boost to the ego of those who need it because there is seldom consequence for this behavior.
There is also a third reason. Some experienced nurses who have worked hard to earn their knowledge and status, especially in the specialty areas like ICU, Surgery, OB, are less prone to be magnanimous toward a new nurse who is not qualified to work in that area. Accordingly, they don’t feel you should be there unless you are exceptional and you must prove that or face isolation. These days, new nurses without adequate experience are being thrown into specialty areas by desperate management that it literally takes years to learn. In these critical areas there is usually not time to teach unless there is a specific Preceptorship program to keep you from killing someone while you are learning. It is imperative to know your own limits and comfort level. Insure that you progress at a pace that is in your comfort zone. You’ll get where you want to be and you’ll know when it’s time to move up to more challenging care levels.
How to Survive the First Year
The first step in survival when you are assigned to someone to orient you or “teach you the ropes” is to determine if that person has your interests at heart. If they love to teach, see it as a privilege and not drudgery, and are kind and patient with you and your mistakes, then you have found a treasure beyond price. If they are short with you, destructively critical, impatient, demeaning, or simply avoiding you, then you need a change of teacher. Go to your director and explain in professional terms without whining that you do not feel your orientation is going as planned, and that there might be a personality conflict and that you would like to have the opportunity to orient with someone else to gain a different perspective. Be honest. In short, find someone to teach you that you can respect and who respects you as a new nurse. This person will have empathy, maturity, and knowledge. You will recognize them immediately because they always stand out. If this person does not exist in your new environment, consider developing your armor and interpersonal skills. However, it is much more simple to just find a place to work where you are appreciated and respected. Don’t hang on in quiet desperation, thinking it will get better when deep down, you know it won’t. Whining, crying, and banging your head on the wall will not accomplish anything except increasing your anxiety and giving you a head injury. Follow your heart and your gut. Your place in the circle will come when you create it for yourself.
Following are some things to think about and incorporate into your new nursing work life.
1. Be Patient - with others and especially with yourself. It is not possible to understand the complexities of nursing in a short period. Do not chastise yourself if you do not think you know everything. That is OK, life is for learning, and you are not supposed to know everything at first. Learn to say “I don’t know” and know how to correct your lack of knowledge. You will not be respected if you try to pretend you know something when it is obvious to all involved that you do not. You will be respected for saying “I don’t know” and then actively seeking out the knowledge and demonstrating what you learned and apply it.
2. It Takes a Year – any complex job takes a minimum of a year to learn. However, we are seldom given that much time. In nursing, you should be reasonably confident after this time and be at a place where you understand that you will be learning something new every day that you practice nursing for the rest of your career.
3. If You Do Not Know, Ask – The quickest way to fail miserably is to assume. There is an old saying: To ass/u/me makes an ass of you and me. Well, it does more than make an ass of you if someone dies because of a mistake that could have been avoided if you had simply asked.
4. Learn Where Things Are – tour your unit with someone knowledgeable. Do it with more than one person. Find everything and remember where it is, even if you have to keep notes for yourself. It will save you so much valuable time in the future you will not believe it. Volunteer to do the outdates on the Crash Cart – know it inside out. Straighten the med room and supply room in your “spare” time. Do anything that will help you remember where to get things and find things. This will foster your independence and make you feel much less of a “newb.”
5. Get Organized – How many times will you run down the hall without tape or scissors in your pocket? How much time (that you already don’t have) will you waste in chasing your tail for supplies? Ask any experienced nurse what they carry in their pockets, they will tell you and even show you. It is very individualized and some literally carry everything they might need. Do not buy scrubs that do not have big pockets just to look fashionable, you will regret it if you are truly there to provide quality patient care. You will probably not regret being fashionable if you are only there to marry a doctor and quit nursing. Find work clothes that meet both needs if you are dumb enough to want to marry a doctor but still want to be a decent nurse.
6. Take Care of Your Feet – they are the only ones you have and they take a beating every shift. Buy the most comfortable shoes you can find, regardless of cost. Take a survey of your fellow nurses and find out what works and what doesn't.
7. Buy a Good Stethoscope – It is your primary assessment tool. A cheapie will not do anything but confuse you with all the artifact they produce. It is your job, and professional responsibility, to accurately assess heart and lung and bowel sounds. You will use your stethoscope a dozen times a shift if you are assessing your patients correctly. Beware: stethoscopes are accidentally (and sometimes on purpose) stolen. Especially a really nice one. The doctor borrows it, usually because they never have one, and then you do not see them again for weeks. Amazingly, when you do see them again, they somehow don’t remember what they did with it. It is in their office, guaranteed. Put your name on it so that it cannot be removed. Have it engraved on the bell. Get a radical color. There are new electronic ones out there now that are simply awesome. It is an investment you will not be sorry you made and it is an investment because they are not cheap.
8. Trust Your Instincts – If your gut is telling you something is wrong, it probably is. Develope and practice this skill every day. It is equally true if something is right. Consult your gut and your heart, they will not steer you wrong. Unless of course, you have some sort of psychological pathology, but then you will not know anyway because the truly crazy do not know that they are.
9. Knowledge breeds Confidence – If you are unsure of something…look it up or ask. Meds, procedures, anything of which you are unsure. Before you go to the patient’s room.
Then understand that you need to be adaptable because the book usually does not cover every situation. Apply your knowledge to the situation and think outside the box or if needed, rely on a mentor. Ask them to show you how to do something or walk you through it or simply be there for moral support. See one, do one, teach one. Remember, common sense is not all that common, but it can be learned and improved to some extent. Then, learn how to think critically.
10. Learn to Chart – If you did not chart it, it was not done. Simple as that. Learn to get rid of the useless verbiage and chart just the essential points. Avoid generalities, they have little meaning and they can be your downfall legally. Chart as if you were being sued ten years from now. Because that is usually when it happens. You will not remember details ten years from now, you think you will, but you will not. There will be too many similar situations and patients. Accurate, succinct, thorough charting will save you repeatedly. Take the time to sit down and read the charting of a nurse who really knows what is important. ICU nurses are generally very good examples because of their experience and skill level. Have one of them that you respect review your charting and give you tips on how to convey the most information with the fewest words.
11. Have Confidence – Especially in front of your patients. Be able to say, “I don’t know, but I can find out” and still conduct yourself with confidence. And remember, almost everyone can tell if you are blowing smoke. Practice self-confidence by expanding your knowledge base, every day. Do not go into a patient’s room to give meds without knowing what you are giving, why you are giving it, what it does, and what it means to the patient. It is the same with any procedures as well, no matter how routine. Why, you ask? Because they will ask YOU! That is what you are there for.
12. Become a Good Teammate – Get good enough at what you do to be able to have time to help others or be a resource for them. If you are always behind, then you are always relying on others to help you. That is fine occasionally, we all need help sometimes, but it should be the exception rather than the rule. Do not be afraid to ask for help when you need it. Just make it your goal to create time by being more organized and efficient and not always be running. When you have this time, offer to assist your fellow nurses when they are behind. Then, because you are good at what you do, usually caught up and able to offer assistance to others you will be creating massive respect for yourself and your abilities, whether you actively seek recognition or not. Nursing is a team sport, some are just better at it than others. Be one of the better ones.
These are just a few suggestions to consider out of the hundreds you will come to know but these basics will stand you in good stead in getting started and finding your directions in the first year. Most of what you learn will come through osmosis and experience, but do not forget the books just because you graduated and never want to see them again. Learning is a career long and lifelong process. There is always more to know and nursing changes constantly.
Remember, when the student is ready, the teacher will appear. When the teacher appears, take respectful advantage of her or him. The situation will not be difficult to recognize, because it is meant for you and you will just know.
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