If you could only give ONE piece of advice to new RNs...
Between what to study, what to prioritize, how to handle patients, coworkers, stressful situations... if you limited yourself to one piece of advice, what do you think would make a new nurse's transition to the job a successful one? An important strategy might not be a clinical consideration, but a personal relations one.
Having precepted some new graduates on the floor and in ICU, and having recently been one myself, if I could only give one piece of advice to any new graduate nurse, it would be this: accept criticism with grace and gratitude. Even if you suspect the person giving it to you is a bully, even if you disagree with them, even if someone else has given you literally the exact opposite advice--give them a smile, as genuine of one as you can manage. Then, even if you'd like nothing more than to punch them in the face, thank them for taking the time to explain the situation to you (or ask them to, if they haven't). Lastly, assure them you'll try harder to be better about whatever it was they were addressing with you. Again, be as genuine as you can and don't be facetious (even if you don't feel justly judged: fake it 'til you make it!) We've all been there. Hearing criticism is never pleasant, but here in this field, nine times out of ten, it isn't because someone is trying to make you miserable, it's for the patient, it's for the unit, and it might even be for your own future success.
Perhaps, you're wondering why this is so important that it would trump what to study, what to prioritize, patient care advice, and a plethora of other things. Of all the things you could tell a new nurse trying to balance many worlds of conflict, why this?
A French professor--one of those existential ponderers whose lectures and metaphorical references went far beyond what our novice undergraduate eyes had read--once said to me, "Of course, we all know the seven deadliest sins. But which is the worst? Pride." Interestingly, he never bothered to explain why, despite the few students who dared to ask, but merely gave a shrewd look from over his reading classes before switching subjects. It's been years since this lecture, and his words still haunt me. We were, at the time, discussing Madame Bovary and not anything relating directly to nursing, but I find the lesson of pride so applicable in this field. To new graduates in particular, why is pride so damning?
The first step is acceptance. (How many self-help books have crooned this one line?) You can't fix the problem if you don't see a problem. And perhaps you really don't see a problem. The problem with pride is that it's the ultimate barrier to change---more so than laziness or fear. Being confronted with something that someone has found you did wrong is uncomfortable at the very least. Perhaps you'll feel the need to defend yourself--don't. To people more experienced than you, a defensive explanation, however polite, is generally unnecessary unless you are doing so in an attempt to figure out together what went wrong in your thinking. Being able to take criticism well (as in: quickly, easily, without a wounded ego) shows your ability to grow. It shows that you're willing to fix whatever might be wrong. Senior nurses find that this is a safe behavior and therefore appreciate it.
But wait--maybe they're wrong. Maybe you have realized that you've struck the unfortunate luck of landing in a hostile work environment and you know this advice-giver is just antagonizing you to be a heartless soul-sucking bully. Even if this is the case, you get nothing by being defensive. This shows that they got under your skin enough to make you feel like you have to defend yourself. Instead, ask them to explain their reasoning. Ask what you can do better. And after all is said and done--very important--smile cheerfully and assure them that you'll do your best to follow their sound advice. If you feed into their ego without letting them bring down yours, they might just start leaving you alone. Wouldn't that be a win-win?
About renardeau, BSN, RN
Renardeau is a second degree nurse who specializes in cardiac populations. Currently working in critical care at a large teaching hospital. An east coaster, a millennial, and an optimist.
From 'DC/MD/VA'; Joined May '10; Posts: 126; Likes: 96.Oct 4, '16I think this sounds like very good advice! For myself, the only thing I would maybe take issue with is unquestioningly accepting direction that contradicts previous instruction. To me that leaves an issue unsettled and I would like to clear that up, albeit with professionalism and civility. Perhaps it's a simple explanation such as x or y makes a or b applicable and that settles it. But I do hope that someday preceptors can equally not let pride interfere with the search for accuracy.Oct 4, '16You're right, and I did worry that it would come off as blatant acceptance of something you inherently disagree with. (In fact, after submitting, I thought I should have taken the time to address it better in the article.) Generally, what I've told people is that as long as you're practicing 'under your preceptor', you should do things the way your preceptor wants them done. That's not to say that sometimes preceptors have practices that may be out-of-date and not best practice anymore, but I think it rubs people the wrong way when new grads are quick to say 'that's not how we did it in nursing school' or 'when I precepted under so-and-so they told me to do it this way', etc. Instead, I think asking for an explanation may imply that you disagree with it in a more ego-friendly way. Personally, if after exploring the problem together, I still don't agree (which has happened), I wouldn't argue that point with the preceptor right then and there, I would probably just agree to do it their way until I gather evidence/support otherwise.
And that's just me---I totally get how some people might feel like it is sacrificing their integrity to continue to do something they fundamentally disagree with. It's always a tricky line to walk when you're orienting to a new unit... not even as a new grad. I've definitely felt frustration from being told multiple contradicting things when orienting with different people or even off orientation and learning new therapies/protocols. The good preceptors are open to different suggestions and don't take offense to when their orientees disagree with them, but I've also seen some well-meaning nurses crucified by some preceptors for 'having an attitude' and quickly gain a reputation for being a 'know-it-all' who doesn't take direction well. Nursing is such a team effort that having your unit distrust you from the get-go could really make life miserable and I feel like preceptors are more often leaders on the unit whose impression of new coworkers could really color existing coworkers' perceptions of them.Oct 4, '16That's good insight. I think upsetting a preceptor sounds like a terrible idea! Personalities can be tricky to navigate sometimes. And I find it doesn't help to just be annoyed by it because that's not going to stop it from being a potential barrier. I'm probably the least combative person I know, but it can be a delicate balancing act sometimes trying to parse out what is the best information without it seeming personal to someone else who may or may not have a low tolerance for inquiry.
Particular to that situation, I doubt I'd be all that attached to "how we learned it in nursing school," but if it's different, I would want to say how I learned it as a way to set up my reasoning for seeking further explanation. I realize that simulation and actual practice are often very different, so a sound explanation from the preceptor would quickly assuage any hesitation in my mind and I'm ready to move on. All I'm after is the best information. If two nurses are saying two different things, I don't care who's right, I just want to know why the right answer IS the right answer..... but I can also see that leading to potential disharmony if the issue is pressed. Ah, the pitfalls we create with our own psychology!Oct 5, '16I cannot think of a better piece of advice to give new RNs (or new employees of any stripe) than the original post.Oct 5, '16Good advice. I particularly appreciate the inclusion of "pride." We all need to be reminded of that sometimes.Oct 5, '16Best advice I have to offer in nursing - or anything is one from my mom. "First things first, second things never".
You can't get bogged down in unimportant things if you remember to always keep your first priorities first. Granted, knowing what is your first priority can be it's own challenge!Oct 5, '16"When in doubt, check it out" and Don't be afraid to ask questions. Don't be afraid to talk your way through why you may need to do something. Don't be afraid to say something doesn't seem right.
Dont be afraid to advocate for ur patient.
Had a patient today tachy and Low O2 on RA. No chest pain , no SOB. Post op day 2 from total knee. Stated she wanted to go home. Just didn't seem right. Called surgeon who didn't want a CTA. She had one kidney with low GFR. He felt she wasn't clinically presenting as a PE and more anemia from blood loss and atelectstasis. X-ray looked like she may have had some congestion .. just didn't sit right with me. Called the medical Doctor because surgeon wasn't convinced. she ordered a VQ scan .. guess what ... bilat PE.Oct 5, '16Quote from dragn2623"When in doubt, check it out" and Don't be afraid to ask questions. Don't be afraid to talk your way through why you may need to do something. Don't be afraid to say something doesn't seem right.
Dont be afraid to advocate for ur patient.
Had a patient today tachy and Low O2 on RA. No chest pain , no SOB. Post op day 2 from total knee. Stated she wanted to go home. Just didn't seem right. Called surgeon who didn't want a CTA. She had one kidney with low GFR. He felt she wasn't clinically presenting as a PE and more anemia from blood loss and atelectstasis. X-ray looked like she may have had some congestion .. just didn't sit right with me. Called the medical Doctor because surgeon wasn't convinced. she ordered a VQ scan .. guess what ... bilat PE.
Good call. Way to advocate and trust your instincts.Oct 5, '16You know the thing that scares your the most? Codes? Giving blood? Assessing altered mental status? Rather than praying that you don't get a patient with those conditions, learn as much as you can about them. Become the unit expert. Immerse yourself, and knock them off your "big scary" list one at a time. It will give you an amazing sense of calm (rather than dread) to walk into the unit/floor every day and this "no matter what comes my way, I got this. And if I don't, I will make it my mission to find out everything I can, so the next time I will know what to do."Oct 5, '16I completely agree with the OP that this is probably the most important piece of advice for new nurses.
I work as a clinical instructor and tell my students that we as faculty try to teach them nursing theory, evidence-based practices, and how to THINK like a nurse but once they graduate and find jobs they will learn how to BE a nurse. Having been precepted and served as a preceptor in multiple healthcare facilities I can say that it definitely requires humility and accepting criticism professionally "with grace and gratitude" (to quote the OP) on both parts.
I also tell my students that during the orientation time they will likely work with experienced nurses who practice and perform certain tasks in a way that is different from how was taught to them. To increase their odds of being successful in a position and being recognized as a good team member it is in your best interest to keep an open mind and follow your preceptor's lead while on orientation. Unless what your preceptor is doing is completely disregarding institutional policy or is dangerous and likely to cause harm to the patient then you should carry out your assessments, documentation, nursing interventions, and workflow as they suggest while you are working with them. If you are working with multiple preceptors it's not wise to say "But Soandso does it this way..." because it can be perceived as staff splitting and comes across as making excuses. If you are offered a suggestion or correction in practice you should (1) listen, (2) thank the person for their suggestion honestly, and (3) verbalize that you will work on incorporating their suggestion into your practice for the future (even if you don't agree with the feedback). At the very least, you should listen to the feedback that is provided to you and reflect on it, you may not agree with it but there is a reason that it was said and it should not be dismissed without consideration.
After you have finished orienting then you can adjust your practices as you see fit (as long as they are within institutional guidelines and are supported) but being a new nurse and starting a position with a mindset that you have nothing to learn is dangerous and doesn't settle well with your peers.
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