Fresh nurse from school

[jameshutch]

So I will be graduating with my RN this upcoming December. Is there any advice to give to a new nurse out of school? I feel pretty confident in my nursing abilities but would appreciate any advice or good stories of starting out!

[Davey Do]

Hi jameshutch! Welcome to AN.com!

Basically, since you sound like you're confident with your nursing abilities, my advice to you would be to be the kind of Nurse you would want as a Patient, or the kind of Coworker you would want to work with.

Good luck to you in your endeavors!

[Male2017RN]

I just recently graduated and was offered a position as a nurse intern in a lvl 1 trauma ER. I did not get offered a job post internship. So my advice is don't start in the ER unless you want a bigger chance of not having a job after the internship is done. I'm the only one who didn't have experience beforehand and the only one not offered a job.

[Accolay]

Welcome aboard!

Nothing really specific I can tell you except all the trite cliched stuff like "keep your nose to the grindstone" and such.

-Your first year is going to be challenging in some way. Take it all in stride.

-Work hard

-They still teach self care in school, no? Do that.

-Take care of yourself physically, emotionally, spiritually if that's your thing.

-Take a vacation

-Eat good food

Good luck!

[xdednrt]

My best advice:

Remind yourself that you don't even know what you don't know.

Give yourself grace and be humble.

Just because school is out, remember that this is when you really start learning.

Take care of yourself but train your mind and body to keep up with the stressors you'll face mentally and physically.

And for the love of God, play nice with your co-workers and patients because if you don't, they'll both make your life a living hell.

[OldDude]

Congratulations!!

Unless your nursing school is completely different than most others, you've been convinced you actually know something about nursing. Unless you've had similar experience prior to nursing school you'll realize you don't know "jack #hi#" when you jump into the trenches. It's like learning everything about how to drive a car before you ever get behind the wheel. You realize what you don't know when you pull out into traffic for the first time by yourself.

Others above have given most excellent advice. What an exciting time for you. Enjoy the adventure and best of luck!!

[nightbrightener]

Male specific advice, may piss off some people....

If you have never worked in a field that is majority female, you may have to get used to a fair amount of gossip and cattiness, some more cliquish behavior than you may be used to, in my and friend's limited experience. You MUST make sure you reign in your ego, it is not about you, it is about the job and the patient. Practice your soft skills, they ARE hugely important. You can't control whether someone else is umm "tetchy", but don't take it personal and just do the job. When I see guys shoot themselves in the foot it is usually because they come off as cocky, argumentative, and as know it all **holes. Be nice, be helpful, be humble, and depending on your background it may take some getting used to. But well worth it.

[Wesley Donovan]

This is just my personal opinion on what your plan of action needs to be in 10 steps:

1. Spend a few days and research hospital locations, their affiliation, reviews, and LEARN which organization pays the best, and treats their employees the best. Unless your planning on moving around the country, you want to aim your target at getting in with the best organization possible for a multitude of reasons even if that means 3 years down the road. It's possible they may not hire you, or take interest in the beginning, but at some point they will if your determined & focused.

2. Then apply to any open Med/Surgical positions WITHOUT Telemetry. These positions can be a bit crazy, but you learn a bit of everything, perfect to branch into a different position later. The cardiac portion of nursing can be very difficult, and this varies a lot based on the type of organization/hospital your working for. When your working with heart problems, a patient can deteriorate out of no where, and if you don't know what your looking for, or aren't confident in reading 12 leads etc, ACLS etc then your going to place yourself under a lot of pressure/stress. For example: A patient I had my last shift was positive Troponin I the minute the patient got to the floor. The ED nurse had consulted the Cardiologist and literally minutes after getting the patient into the room, the Cardiologist calls and the first thing he asks me on the phone is what Artery is affected. What this translates to: "Which artery is affected on the 12 lead the patient just had", in which I had already reviewed the 12 lead report prior to the patient's arrival and was able to tell him quickly. He then asked some basic questions followed with an order to prep the patient for the Cath lab. In this case the Cardiologist already knows this patient outside of the hospital, so he was only interested in specific information. However, when I was a new grad, this would of confused the hell out of me.

3. If you get an interview at a place that is less than the best, it's likely they have a lot of internal problems, so showing up and demonstrating leadership qualities, DOING THE RIGHT THING, taking care of business no matter what, and being responsible is what will look good. Turn over is generally a problem at these places, so if you can show from your work history your not a job hopper, point it out. The managers are generally nurses themselves, so they already know as a new grad you don't know practically anything about the job, which is why it's good to show them the framework to be a good nurse is there.

4. If you get the job, you should always get an "Orientation Period". It's really important to try make sure you get more than a month. If they say "Oh we're going to give you 3 shifts with a preceptor", you should speak up and ask for longer. Those who don't ask, don't get.

5. When you do the orientation part, use every opportunity to learn more about your position. Questions to ask: What types of patient problems are common here? Any surgical cases admitted on this floor? Where are the extensions to call other departments? Ask as many questions as you can, write them down. If the nurse is telling you: "We get a lot of patients with Cholecystitis or Pancreatitis...", then do the smart thing and learn the hell out of that at home.

6. Ensure you ask what the sick policy is, do they use a company e-mail, how is the schedule made?, can you make your own, is there a website to do your schedule? How much Paid Time Off do I accrue, is their weekend percentage bonus etc. Ask all these things, so you don't get random curve balls from the manager.

7. Learn what physician groups are present. Often times hospitals contract with a group of physicians (Internal Medicine) doctors. Try learn how this group works, how they round, how to contact them, and what expectations they have. For example does the Internal Medicine write orders for pain medication or does the surgeon? Every hospital has a system with physicians, try learn how the place your at functions with their physician pool, it often times won't be the same at a different hospital organization.

8. When you get established, have a routine etc, start learning the cardiac stuff, get your ACLS, and learn as much as you can about the heart, 12 leads, read forums, do whatever you can to enhance your knowledge. You want to bring this knowledge, with ACLS certification so you can move into a Telemetry unit or a Telemetry Observation unit (Which I work on).

9. When you have two years experience, start applying back to the place you wanted to work at, and try use any resource to get in with a job opening. Often times, if your persistent, you will get an opportunity. I was told that 15 people were interviewed for my position, and they gave me the position primarily because I had worked up to charge nurse quickly at my first position. Leadership, confidence, and knowledge at this point are things the manager wants to hear.

10. The final and absolute most important thing, KEEP LEARNING, use Youtube it's the best resource. The whole reason to get into a better hospital is not just for the increase in pay/benefits, but to be around hopefully more skilled co-workers. In my situation, my unit is an extension of the ED. I take on literally every last thing you can think of. Sepsis, Chest Pain, MI, Stroke, Trauma, Chole/Appy, Fracture, Arrhythmia, Kidney/GI problems, Psyche etc. We consult with every MD specialty, always getting calls from physicians or call them. There are so many situations patient's almost code or do code and I feel I could do the protocols in my sleep, it's instinctive. This is where you want to aim, because there after you can move to ICU or ED itself, and also stand a good chance of getting into specialty positions which compensate well.

[Rondo]

Thanks for this post, Wesley. I am about to begin an ABSN program this summer with intent to end up working the ER, so this is a very cool mapped out route to end up there confident and capable. I oftentimes hear from nurses that it would be best to start out in Med/Surg when entering the field, but I also have had a handful tell me that you can start wherever, just that it would be quite a bit more challenging... but that it could be done. I think after reading your response to this post I want to follow your advice. I know nursing will be a whole new world I will have to figure out at the right pace if I want to end up in the position I see for myself.

[Concerto_in_C, BSN, RN]

It's a sexist industry that believes men should work in critical care or ER. Or they believe men should be nurse anesthetists and stuff like that. So if you are trauma helicopter nurse or a critical care nurse they will like you because that fits their expectations. But in lower acuity settings you will have a lot of competition and you will meet managers who don't always like men on the floor. I've never worked in critical care so I fail most interviews. For last 3 years I've survived thanks to contracts. Contract agencies will always hire you because travel agency jobs are worthless. They pay a good hourly rate but that's the least important thing when you are looking at the whole compensation package.

[NICU Guy, BSN, RN]

It's a sexist industry that believes men should work in critical care or ER. Or they believe men should be nurse anesthetists and stuff like that. So if you are trauma helicopter nurse or a critical care nurse they will like you because that fits their expectations. But in lower acuity settings you will have a lot of competition and you will meet managers who don't always like men on the floor. I've never worked in critical care so I fail most interviews.

Maybe location is an issue for you. I have not seen any hint of bias against men. Granted I work in an ICU, but it is a NICU and changing diapers and bottle feeding babies is not very "manly". I never got any issues for being a male in a non Adult ICU/Trauma/ER. There are several male nurses in the children's hospital working Med/Surg and Oncology. I work with 300 female nurses in my unit alone and not one word about "Men shouldn't be in nursing". The same goes for every doctor and parent that I interact with.

[DannyBoy8, RN]

Hi jameshutch! Welcome to AN.com!

Basically, since you sound like you're confident with your nursing abilities, my advice to you would be to be the kind of Nurse you would want as a Patient, or the kind of Coworker you would want to work with.

Good luck to you in your endeavors!

Step 1: Don't be overly confident in your abilities.

Step 2: Ask for help.

Step 3: You should be listening for at least as much time as you're talking, if not more.

Step 4: Don't fart at the nurses station until you're off orientation. If you do, better make it silent ;-)