Big difference between last day as student and first day as RN?

Chaya, ASN, RN · May 29, 2007

Your question brought me back to day one! For me the difference between being a nurse and being an aide was both definite but subtle because I came back and worked on the same unit after orientation. I didn't have to get used to finding things in a new place, etc. but what was new was the awareness of ownership. Yes, I had a mentor- but I couldn't call the nurse, because I was the nurse. There's the chain-of-custody thing; you can't leave until another nurse has officially assumed care of all your patients.

CHATSDALE · May 29, 2007

different people have different experiences, if you can get some first hand experience it will be helpful but being a student can be a full time job in itself..whether or not you do have aide/tech experience it will take you 6 onths to a year before you as confident as you would like in the skin of a nurse

jjjoy, LPN · May 29, 2007

It can also depend on the program one attends. In many programs, the nursing students never take a full load of patients (often just two) and never have the full spectrum of nursing responsibilities to cover during their time as a student nurse. Heck, in most programs, you don't even learn how to start IVs and you've likely only performed certain common tasks just 2 or 3 times (foley catheter insertion, certain types of dressing changes, etc).

As an example, a student may have helped with one or two patient discharges. They may have been straight forward, just fill out these couple of forms, family and patient escort takes them away. When you start working, you now run across a patient discharge to take care of. 1) You've got several other patients with all of their own demands taking you away from completely focusing on the discharge. 2) Each facility has their own paperwork and it's likely that as a student you never worked with this specific paperwork. 3) This patient may need a social work consult or there's an unclear order that must be clarified or whatnot... something that when you were a student, the nurse was aware of and could cue you into, give you the proper forms, tell you who to call, etc... but as the nurse now yourself, you've got to stop and ask a colleague who isn't familiar with your patients, is also busy juggling all of their work and and may at times not be able to stop and help you.

Yes, there is orientation for new nurses, which is mostly no more than 6-8 weeks (which can end up being less than 15 twelve-hour shifts). More hospitals are offering longer probation and training periods for up to six months in specialty areas as it really it is everyone's best interest to allow a longer transition period.

If the clinical training concerns you, research what the different local nursing programs offer in terms of clinical training. Don't just look at number of hours but also what's the ratio of students-to-instructor as well as does the program have a senior practicum or externship opportunities where the students work one-on-one with a nurse for a term to give them a more "real world" experience. You can also ask working nurses what their experience with graduates of different local programs and how "floor-ready" they seem as new hires.

jjjoy, LPN · May 29, 2007

Oh yeah, nursing school often also focuses on things like patient-nurse relations, building a trusting relationship, patient teaching, empowering patients, patient advocacy etc... but on the floor in most hospitals, sometimes it seems there's barely time to check if all of your patients are still breathing between all of the paperwork and other stuff that needs to be done (take off new orders, call pharmacy for undelivered meds, call MD for new development, get this med delivered by that time and check back every 15 minutes for adverse reactions... oh yeah and try not to rush that little old lady as you escort her to the bathroom because you need to get back to check on the man down the hall and your assistant couldn't help because she's giving a tap water enema to yet another patient.)

LeesieBug · May 29, 2007

Well, my first day as an RN was like being back in square one as a student....

That's the only way it was different...oh, and I got to sign my name with "RN" after it. That was cool, indeed.

Seriously, nursing school gives you a FOUNDATION on which you can build as you actually LEARN to be a NURSE in your first job. As you progress you start to have "AH HA" moments, putting things you learned from school together as you do your pt care....you start moving from being task oriented to putting it all together.

llg, PhD, RN · May 29, 2007

My first day as an RN was many years ago, but I distinctly remember being aware that I had gone from being a "high ranking senior" student who had mastered the things I was expected to master, to being a "lowly new grad" who knew less than anyone else in the hospital. Instead of being at the top of the student ladder, I had moved to the bottom of the RN ladder.

I see a lot of new grads struggling with that aspect of the transition. Some have trouble coping with the fact that the hospital and their coworkers don't see situations as being "all about them." As a student, they were in an environment (the school) that existed to serve their need for an education. They received constant feedback about their performance and rewards (good grades) for good performance on a regular basis. As a hospital employee, the environment exists to serve the patients and good performance on the part of the staff is a basic expectation. There are usually no special rewards for good performance, unless you count the paycheck (which you really should count, but most people don't). Many rewards are linked to seniority and to the ability of the nurse to meet the needs of the administration.

It can feel like a demotion instead of a step up -- and some new grads get so disappointed that they feel demoted rather than promoted, that they can't handle it and leave. It may not be the only reason they struggle and/or leave, but I believe it is one of the reasons for some people.

willdgate · May 29, 2007

it is not that i did not see it coming as a nurse intern, but as an intern you are not accountable for nursing actions. however, as a nurse you are accountable as well as responsible, which puts a lot of stress on yourself. nursing is nothing like nursing school imo, b/c of the long hours, and nursing politics. in nursing school you are in clinicals in the am, but as a new grad you will rarely get the day shift. also, papers mean nothing, just paperwork, paperwork, paperwork. :uhoh3:

pagandeva2000, LPN · May 30, 2007

I have 2 years to go before I see the day I'm an RN, so after reading several threads I have a question. What makes that first day as an RN so different from the day before?
I'm assuming most people work as a patient tech or nurse extern while going to school. Some posts make it sound like they never saw it coming; like nursing work was more difficult, stressful or depressing than they ever anticipated, and that they never discovered this until after graduation.

The difference is that once you have passed NCLEX, you are basically considered to be responsible for yourself. As a student, the clinical instructor probably chose cases that were not that complicated (that depends, because some instructors may, in fact, challenge you), was a resource, and at that time, you are working under HER license, so, she will NOT let you screw up but so much. On the other hand, as a licensed professional, you are now allegedly able to use your nursing judgement. Also, you may not have had many patients, and was able to work at somewhat of a predictable pace. I was a patient tech, and then became an LPN...even that was a BIG difference. I can only imagine the transition from a person with close to no medical experience to becoming an RN. I have been a nurse since July, 2006, and am still in a state of utter shock every now and then...maybe not as much as before, but it is a wake up call.

Be sure while you are in school to obtain all of the resources you need, and when you get hired, make it your priority to look at the policy and procedure manual. Best wishes...somehow, we ALL make it if we really want to be nurses.

hlfpnt, BSN, RN · May 30, 2007

I think some of the problem is the fact that in school you learn the "ivory tower" way of nursing...the perfect world. Once you're in the "real world" of nursing you realize it's not perfect & very rarely is the situation "ideal". Also, as other posters have already stated, it can be overwhelming when you realize you are the one responsable.

tamari07 · May 30, 2007

When you're in nursing school you probably have one or two patients in clinical who you maybe pass out a few meds, chart a little bit, do AM care. But when you're the RN, you have 5-6 patients who you have to do EVERYTHING for. You have to pass meds, chart everything you do, do AM care, call the doc if you need something.... its all very very overwhelming. Now that I've been an RN for a year, I have found out the importance of time management and prioritization. You have to know what you need to do first and what can wait. Now that it has been a year for me I'm feeling more confident in myself. Its just a matter of time, but your confidence will come. Good luck!

dmn1012 · May 30, 2007

Well, it is my second night tonight off of orientation, I call this period nusrsing boot camp! Hang tough and become a trooper!. I love what I do, i am on a surgical floor, ortho, gyno, general mixed w/ some medical ( I dont know what is going on where I am but lately we seem to have just about everything.) My first night off orientation I had 8 pts two were vents! I just took my time w/ unfamiliar things , still asked a lot of questions (someone is always there to help) I had a routine w/ my preceptor but once you are on your own you find you own method to the madness.. If I have touched one person in a way that made them feel better on my shift, I leave knowing that I did a good job, even on the crappiest shifts!!:trout: :pumpiron: