New grad nurse about to start first nursing job

jadelpn, LPN, EMT-B · Jan 30, 2015

You can only go in, learn what you can, do what you can and stay organized. It may be overwhelming. You will have questions (and you can look to your nursing books/search engines and look stuff up after shifts you are not clear on).

Learn to do a great assessment, learn to look at the whole patient, and make sure you know what med you are giving for what to who (and the rest of the 5, 6, or 7 rights of medication administration)

Best wishes!

vanilla bean · Jan 30, 2015

Good advice from jadelpn. Also, many people find using a good brain sheet very helpful to stay organized and for keeping important info at your fingertips during your shift.

Don't know if you've discovered this forum yet: https://allnurses.com/first-year-after/ but it's a whole forum dedicated to nurses tackling their first year after licensure.

Good luck to you!

iPink, BSN, RN · Jan 30, 2015

It will be scary. It may be tough at first. You may not like it. But remember you're being molded to become a confident and competent nurse in critical thinking, time management, clinical skills, and so on. The process in itself isn't always enjoyable but it is certainly necessary to provide safe patient care. It WILL take time so you have to give yourself the appropriate time to get always improve.

Confidently speaking with patients and MDs will improve the more you do it. Practice, practice, practice. Carry a pocket sized notebook to write down information that you need to review. Know your unit protocols. Ask plenty of questions.

You have spent the money on nursing school and the NCLEX, so at this point you may not want to start questioning if nursing is right for you without even working as one. Do yourself a favor and put away the negativity.

Good luck!

BTW, I journaled my first year of nursing and when I look back on what I wrote, you would have thought I was going through boot camp, not knowing if I was going to make it out alive. I did survive and grateful for my experience.

Sent via iPink's phone using allnurses

thenightnurse456 · Jan 30, 2015

I agree with the above posts, it's going to be scary. I'll copy in some advice I have a new grad tele nurse. Some things will apply to you.

DAY SHIFT 7-7pm.

1. I always liked to come in to work 10 minutes before I started (many people don't agree with this but it helped me so much). In this time I would check my assignment, read charts, check orders, check labs, check telemetry monitors. This allowed me to develop a small picture on my patients before I even received report.

2. Does your unit do bed side report? During report I would assess the environment at the same time.

Eg: Patient As fluid bag is nearly empty, I'll know to bring a fresh bag in before I do my head to toe assessment. Saves an extra trip back and forward. I would finish my brain for the shift: when meds/dressings etc are due.

3. After report I would assess patients generally based on acuity. Head to toe. Make sure you check your IV lines! Administer their medications and provide assistance with setting up for break fast. Hint: If I had diabetics who needed a finger stick and insulin with breakfast, I would assess them first as breakfast trays often came between 7.15 and 7.30.

4. After assessments and meds are complete I like to get started with patients' hygiene cares. My floor was total care so nurses did all showers/sponge baths/ make beds etc. Your facility would probably use CNA/techs.?

5. After everyone's hygiene cares were complete I would probably take a break myself. Look after yourself! Your patients wouldn't appreciate you collapsing on them!

6.Dressing changes, more medications, answering call lights, admissions, discharges, rapid responses, codes, falls, time consuming patients and relatives! All this things and more are what will slow you down. Ah the joys of the floor! It's because of these constant interruptions that I would (when safe and legal) cluster care.

Eg: my patient A needs a picc dressing change. hospital policy says I have to change the bag and line with the dressing and the patient has an antibiotic due at 10. So I'll do the dressing and antibiotic at 10 to save multiple trips back and forward.

7.hourly round. Trust me, you might think it's annoying and tedious but this will decrease your call lights/complaints and increase patient satisfaction. But more importantly, you will always be in the loop with your patients and their needs. Trust meeee this will be your greatest tool on the floor.

8. Chart as you go. Seems impossible at times but trust me!

Medical floors are a great learning experience! You'll be a pro in no time :)

hollybambam · Jan 30, 2015

Thank you all for your replies so fair. I really do appreciate the advice. Reading back on my post, it does sound a bit spiraly. I'm just really trying to get it into perspective. I genuinely do enjoy nursing I think. It's all happened so quickly! I still feel so very green and student-ey.

I know I can do it, but I do know it wont be without struggle as you guys have said. I feel like the days are approaching so quick! Hell, I still feel like a kid!.

Gooselady, BSN, RN · Jan 30, 2015

Try not to 'borrow trouble' from the future, like worrying "will I like it, maybe I won't like it . . ." Be open to being surprised in a positive way! You are correct in that you are entering the 'real world' now, it will be quite different, different enough that you may be pleasantly surprised. Chances are just as good you'll like it more than you thought than the other way :)

I was pretty shy, not a social butterfly when I entered nursing. One thing about nursing, though -- it teaches you (well, kinda forces you) to become a 'people person'. I can chat up anyone about just about anything, and I chalk that up to being a nurse. It wasn't hard or unpleasant to 'learn' to be a bit more extroverted, it just came with the territory, and I realized some years ago that I USED to be more reticent and quiet I can be the total 'people person' if I have to be, and the rest of the time, I revert to original form :)

Your first job, which you've been anticipating SO long, is almost upon you. Your brain is going to over do the anxiety-thought anticipation. If you can, just sort of 'let go' of your expectations, and just be very present, alert and open minded when you hit the floor. You do not have to be perfect, and no, no one expects you to be in spite of all appearances to the contrary. Just make your mistakes ONCE.

Heck, try not to THINK at all :) cuz everything your mind tosses up to you now is not really going to apply. Isn't that great news ? Congratulations on landing an excellent job for a new grad, and think of it as 'continuing education' rather than you being on stage needing to perform perfectly.

hollybambam · Jan 30, 2015

Thanks Gooselady (hah),

I like what you said about being present and in the moment. Is it wrong of me to feel as though starting this grad position is just another thing that I'm doing with my life at the time? That's what uni essentially was, me just working towards something, one bit at a time.

I think I'm mostly fearful of the "what if", and if I've poured much effort, time and money into something that may kill me. I guess I wont know until I try, which is the mindset I'm trying so desperately to apply.

There's also the concern of others being disappointed in me. I'd be lying if I said that wasn't a factor. I know I can do it, but I also want to want to do it. I'm trying to avoid the horror stories of the nurses that genuinely hate their job, because to be fair, I'm not really like most people (not intended to sound self-inflating, simply true). I don't want to waste any of my life. I know how little time we have. I want to be comfortable, but I also understand that we've gotta do what we've gotta do, and sometimes it's less than favourable.

roser13, ASN, RN · Jan 30, 2015

You can only do one day at a time.

I know for a fact that on your first day, you will not be in charge of anything. You will not have to start an IV, monitor anyone's vitals, or start CPR on anyone. Heck, you likely won't even set foot on the floor.

Whew! That means that the first day will be fine! That's the only day you need to survive for now.

No need to even THINK about Day #2 until Day #1 is over. And Day #1 will surely give you information about Day #2 and you will be able to mentally prepare yourself. And so on and so on. Each day will help you build up to the next.

One day day at a time. That's how I do it:yes:

firefly84 · Jan 31, 2015

Uncertainty is a trait that seems to run through the veins of all nurses. We are constantly wondering if we could have done something different or better. From what I can tell, it's definitely in your veins...seriously. It might not seem like it now, but it's a good trait. When we constantly question ourselves, it is used as a tool for improvement.

So, you still aren't sure if nursing is for you, but...

you applied and got into nursing school, then...

you survived clinicals and developed your interpersonal and critical thinking skills

you spent hundreds of hours doing careplans, reading thousands of pages of material, memorizing countless drugs and diseases

AND

you got a degree, passed your boards, and got a job.

That sounds like someone that deep down knows exactly what they want to do. There were a lot of times that you could have stepped aside and decided this wasn't for you. Instead, you kept going. Now you, like most new grads have some doubts.

Take things as they come. Approach this with an open mind. Ask questions, ask lots of them. This is your opportunity to soak in a huge amount of knowledge. You are always going to learn. There isn't a magical cut-off date that says you quit learning after 1 year of being a nurse. There is however, doubt and uncertainty, that will occasionally surface again. It happens to the best of us.

When you experience your first code, you will wonder why anyone could do this as a career. Then you will see a grateful family who is thankful for you care and compassion. You will remember why you are a nurse.

When you hand a new mother her baby for the first time; you will remember why you are a nurse.

When someone thanks you for just being there in a moment of need; you will remember why you are a nurse.

I have a good feeling about you...

Career Columnist / Author · Jan 31, 2015

Congrats on getting a new grad position! You must be one of the cream of the crop applicants! It's too soon to know if you will be happy in nursing or not. Put that on the back burner.

You said you're not a people person- if, in the future, you find the constant pt contact to be too draining for you, there are a myriad of non-pt contact positions you will qualify for.

Best of luck!! Nurse Beth