From Nursing Student to Nurse: Smoothing the Transition

[Ruby Vee, BSN]

Transitioning from a nursing student to a nurse is one of the most difficult role transitions you'll ever make. It's right up there with a cross country move, getting married or divorced, having a baby or losing a close family member. The learning curve is a steep one, and not everyone's transition is a seamless one. As someone whose transition was a bit rockier than most, I'm probably well qualified to give advice.

A nursing license is a license to learn, and we're all learning every day of our careers. Some of expand our knowledge base and deepen our understanding of pathophysiology, disease process, pharmacology, etc. Some of us "learn" the same thing over and over and never really progress. Some of us learn professionalism and how to get along with our colleagues, and others of us --- don't.

Ask questions. There is nothing that scares a preceptor more than an orientee with no questions. Either they think they already know everything (which makes it impossible to teach them anything), they're too shy to ask the question (which makes me wonder if they're also too shy to clarify an order with a brusque physician, advocate for their patient or be firm with an inappropriate visitor) or they haven't thought about the situation enough to have formed a question. Now that's truly terrifying!

At the same time, ask the right questions and ask them the right way. Carry a notebook with you and write down the answers so you can remember the information the next time you need it rather than asking the same questions over and over. After six weeks in a SICU where every other patient had a Swan/Ganz catheter, I had an orientee ask me "now what is that yellow thing sticking out of his neck?" She should have had that one straight at the end of the first week, if not the first day! Another example of a wrong question to ask your preceptor, especially on the first day, is "I'm not really gonna have to work 50% nights, am I?" (Your offer letter offered you a rotating position, 50/50 days/nights. Yes, you're going to have to work the nights.)

The scheduling coordinator tells me she can accurately point out which new grads aren't going to last by the end of the first day. "They're the ones with requests off for every weekend and holiday, or the ones who expect their preceptors to accommodate THEIR preferred schedule," she says. I'm not sure she's 100% right with her predictions, but she's pretty close!

Most hospitals have their policy/procedure manuals on line these days. If they're not on line, they'll be in a prominent place on your unit. One of the very first questions you should ask is where to find these valuable resources. Also a medication reference -- usually online -- a lab reference, and a phone list. No preceptor likes being asked "now what's the number for the blood bank again?" a couple of dozen times in one day.

An example of a good question would be "I've got an order for a Foley catheter, and I've never placed one before. I've gathered the equipment and I've printed out the procedure. Could we go over it together before I go talk to the patient?" It shows you've taken the initiative to look up the procedure, gather the supplies and seek supervision. That makes for a happy preceptor. "I gotta put in a Foley. What do I do?" makes an unhappy preceptor. Another good question: "I have only one IV line, and it's got a heparin drip going through it. The IV Lasix is due, and the med guide lists them as "possibly compatible." Do we have to start a new line or can we just hold the heparin and flush the line well before and after the lasix is given?" A bad question would be "How do I give the Lasix?" and a worse one would be "I gave the lasix in the line with the heparin, and there's a bunch of cloudy stuff in there now. How come?" You see the difference, right?

Respect your preceptor. You don't have to like her, but she's senior to you and more experienced than you. She can teach you a lot, even if she's not a good teacher and had to have her arm twisted before agreeing to precept. Often times, your preceptor will be older than you as well. Ever heard the term "Respect your elders?" Please do. A preceptor you regard as "an ugly old hag," "an old dog who can't learn new tricks" or "a crusty old bat' will sense your attitude (and perhaps treat you accordingly). There's no excuse for rolling your eyes when your preceptor asks you for the thirteenth time whether you've washed your hands. Just say "yes" and move on. Saying "I already did that once" when offered the chance to change a VAD dressing, place an NG tube or give an injection is not only bad manners, it's stupid. Yet I see orientees doing that all the time. Orientation is a good time to perfect those nursing skills you're learning, and once is not enough. If you're going to stand around with the other orientees and bash your preceptor, please do it where NONE of the preceptors is going to overhear you. I once walked off the elevator in the parking garage with a brand new preceptor only to hear his orientee loudly complaining about him to several of her friends. That's bad manners, poor judgement and perhaps even bullying behavior as well.

Learn to take criticism constructively. Not all criticism will be delivered in the manner in which you prefer to receive it, and some may be delivered rather more brusquely or directly than ANYONE wants to receive it. Some preceptors are really bad at giving constructive criticism. (Usually it's not because they're mean, it's because they're so anxious about having to give negative feedback that they just blurt it out, or because their communication skills aren't as developed as yours or because they're from New York City. ) The fact that you don't like the way the feedback is delivered doesn't mean it's not valuable feedback and does not negate the possibility that you can learn from it. And while we're on that subject, the fact that you don't agree with the particular criticism does not mean it's inaccurate or less than valuable, either. Maybe you're right, but maybe you're not. If it's offered, try to learn from it.

Understand that our first responsibility is to our patients. If I see you doing something that might harm that patient, I'll stop you. I'd prefer to do that nicely and in private, but if I have to yell "STOP!" in front of God and everyone, I will. Don't take it personally. It's not about you; it's about the patient.

You will have to study at home on your day off. I've had to do so every time I've changed jobs, and even more studying when I've changed specialties. It's impossible to learn everything you need to know while you're on the clock. Understand that you WILL need to study at home, and just do it. Whining about it doesn't make a good impression on managers or preceptors. Refusing to do it makes a worse one. Your educator or preceptor will probably have specific things for you to study at home, or can suggest material to go over.

Adhere to the dress code. Every year there's one (or more) orientee who has to be told that her thong is showing, that her scrub top is too small, that rolling your scrub pants down is a bad idea, that deodorant is a good idea or that orange "Gay Pride" or "I Drank so Much I Fell On The Floor And Couldn't Get Up" T shirts underneath white scrub tops are inappropriate. If the dress code says only two earrings per head, take out the other 13 before you come to work. If the dress code says "Offensive tattoos should be covered," make sure yours are. Even if you don't think they're offensive, someone else might. After orientation when you've proving what a terrific nurse you're going to be some day, you can discuss with your manager whether or not your tattoo requires covering.

Be friendly and approachable. You don't have to change your entire personality, but you do need to get along with your colleagues. If someone asks you how many kids you have, the correct answer is "none yet" or "3 boys and a girl," not "I don't believe in bringing more bodies into this world when pollution is ruining our planet" or "What business is it of yours?" Chances are, the person who asked was only trying to be polite and get to know you better. Same goes for "Are you married?" or "What church do you go to?" (especially in the south) or "do you live in the city?"

i'm sure there are hundreds of things I've forgotten, but this is getting pretty long so I'll leave it for the other preceptors on AN to fill in. Good luck in your new job and your new career. We're happy to have you on board. Really.

[melizerd, ASN, RN]

Thank you! This is fabulous! I'm a new grad and will be starting my first position shortly. It's nerve wracking and terrifying but this is a great read and reminder.

[Pepper The Cat, BSN, RN]

I love you more and more each day!

another thing not to say: if you ask about a procedure and then get a response, don't then go and "check" with another nurse to see if you were given the correct info. We had a new grad who would do this. She would ask every nurse working the shift with her how to do something, and only after getting the same answer each time would she do the procedure.

And I don't care what the policy is at Hospital X, we are at Hospital A and that is the policy we will follow.

[Lev, MSN, RN, NP]

Love this!

[LadyFree28, BSN, LPN, RN]

Well said-from a preceptor-turned transitioning nurse; the curve is steep, indeed.

[nynursey_]

I think there's a fine line between accepting your preceptor for who he/she is, and realizing that you and your preceptor are just simply not a good fit for one another, and you might learn better from a different teaching style. I have seen this numerous times throughout my time on the floor, and I've seen it handled both tactfully, and poorly. Simply because you and your preceptor do not mesh well doesn't mean either you, or that person, are bad people--it merely means you may be suited for another person. You do not need to finish out your preceptorship under that person just because they're your preceptor. You can find a tactful way--if it's possible--to learn under someone else. Don't be afraid to speak up.

I do, however, agree with not publicly bashing one's preceptor. A big no-no.

[ceebeejay]

Love the post, but I'm from NY - It's a big, diverse state, not just what you see on t.v. :)

[4boysmama]

as a soon-to-be-graduate (hopefully with a job not long after that!!) I appreciate this post very much.

(and as a former NYCer....I'm hoping to get a preceptor who tells it like it is )

[Ruby Vee, BSN]

as a soon-to-be-graduate (hopefully with a job not long after that!!) I appreciate this post very much.

(and as a former NYCer....I'm hoping to get a preceptor who tells it like it is )

Preceptors who tell it like it is are unpopular -- everyone SAYS that's what they want -- until they get it. Nevertheless, I wish you luck with yours.

[Ruby Vee, BSN]

I think there's a fine line between accepting your preceptor for who he/she is, and realizing that you and your preceptor are just simply not a good fit for one another, and you might learn better from a different teaching style. I have seen this numerous times throughout my time on the floor, and I've seen it handled both tactfully, and poorly. Simply because you and your preceptor do not mesh well doesn't mean either you, or that person, are bad people--it merely means you may be suited for another person. You do not need to finish out your preceptorship under that person just because they're your preceptor. You can find a tactful way--if it's possible--to learn under someone else. Don't be afraid to speak up.

I do, however, agree with not publicly bashing one's preceptor. A big no-no.

I'd urge everyone to be careful about requesting a new preceptor. Many managers -- mine included -- feel as though learning to work with a preceptor who isn't the best fit for you is part of growing up and learning to navigate the real world professionally. An orientee who asks for a new preceptor may or may not get one -- depending upon the available preceptors -- but she WILL get a black mark. And orientee who asks for a change of preceptors more than once usually does not keep her job. It is considered that the orientee has difficulty working well with others. I would encourage doing your best to work things out with your first preceptor.

[nynursey_]

I'd urge everyone to be careful about requesting a new preceptor. Many managers -- mine included -- feel as though learning to work with a preceptor who isn't the best fit for you is part of growing up and learning to navigate the real world professionally. An orientee who asks for a new preceptor may or may not get one -- depending upon the available preceptors -- but she WILL get a black mark. And orientee who asks for a change of preceptors more than once usually does not keep her job. It is considered that the orientee has difficulty working well with others. I would encourage doing your best to work things out with your first preceptor.

While this might be true at specific hospitals, it wasn't true for mine. And honestly, I think it's al in the way you phrase the request and if you're leaving the situation on poor terms. If you've treated that preceptor with disrespect throughout your time together and THEN request a new one, it obviously reflects very poorly on you. But if you've given it 100%, been receptive, and you still feel you aren't learning and/or making progress, then that's a different story.

Many facilities push employers into becoming preceptors and they reluctantly do so. These people have an obvious lack of enthusiasm when it comes to teaching and as a result the preceptee learns very little. I know because I had one of these people. She very blatantly told me, "I'm going to be honest--I don't like taking orientees. I'm pretty bad at explaining the details of things. I'd rather just go on about my day and do my job." I blinked at her, stunned. I actually felt bad for her. She didn't want to mentor me one bit, but did so to earn points towards promotion. And I'm sure this situation is not unique to my hospital.

Feel out the situation before committing to request another preceptor. You have a right to learn.

[rubato, ASN, RN]

Thank you for all the information. I'm going in for my first interview next week, and all of this will be incredibly helpful for me when I get that job. As an older new grad (almost 44), a lot of this is just common sense, but I see a lot of my fellow students unable to grasp some of these concepts.