New grad RN with some really huge shoes to fill...

[Stephanie066, BSN, RN]

Where to start...I just graduated from nursing school this past May. I worked as a CNA at a SNIF during my last year of school and they offered me a per diem RN position when I passed my boards. However, just days into my orientation they begged me to fill a full time position that had unexpectedly become available...So, here I am fresh out of school and 3rd shift supervisor. I don't know about other facilities policies but mine requires that there be at least 1 RN in the building on 3rd shift, and because most of the third shift staff are LPNs I will be fulfilling the requirement. So not only will I be responsible for my 60 bed long term care unit but also in part for the 50 bed rehab/subacute care unit. A whole lot of responsibility for my first RN job..although usually a very confident person I find myself feeling somewhat overwhelmed.

My main concern is earning the respect of the other nurses as well as the aides and others I will supervise. I often feel that the nurses second guess me on a lot of things or discredit my concerns/assessments etc, which is not only discouraging but also frustrating especially since they have told our DON that my skills are far better than they would have expected being that I am a new grad. Now I understand they have the right to challenge my judgment and I am ok with that but they do it in a way that is very belittling. For example a resident developed a boil so I cleaned with NS and applied a warm compress for 15 minutes (just a facecloth moistened with water from the sink in the patient's room inside of a bag) so when reporting this to the unit manager in the morning she stopped and yelled at me right at the nurses station because unbeknownst to me and all of the other nurses on shift nurses are never allowed to apply heat...EVER.

My next biggest concern is being an effective leader on my unit...since I was a CNA at the facility before I became an RN I have found it hard to transition into a role that requires me to supervise the people who were previously my piers. In addition I am far younger than all of the aides and I can sense that a lot of them feel that my requests and expectations are somehow less credible because they are coming from a 21year old new grad nurse.

Ok I know that was a lot to take in...but I would appreciate and any advice that anyone is willing to offer!

[HouTx, BSN, MSN, EdD]

As a clinical leader, one of your most important duties is to ensure that all organizational policies are followed. Make sure you are very familiar with them so you can interpret them for subordinates if necessary; application of heat without a physician's order is probably covered in those policies.

Some state BONs, including mine, have specific guidelines about when a new grad can assume a supervisory position without immediately available backup from a qualified RN. Make sure you are familiar with yours. It goes without saying that you should also have your own Liability Insurance if you are in a nursing leadership position.

You should be provided with additional training to prepare you adequately for your new leadership position. As the 'senior' person, you will be making decisions that not only affect your patients, but also the organization. Some of these decisions can have significant consequences in terms of liability. If your organization is not providing any training, find out if they will pay for training from an external source. The higher your position, the greater exposure to personal liability you will have.

Trust is an essential component of the relationship between a leader & subordinates. I encourage you to focus on developing this as your first priority. As the 'only' RN, you also need to make sure that your actions show that you respect and value the contributions of other members of your team.

Best of luck to you in your new role.

[amoLucia]

This is a little bit late, but you should be carrying your own malpractice insurance.

Any and all nurses really should be carrying their own coverage, esp newbies. Making clinical and administrative decisions carries risks for all. We all have homeowners' and auto insurance for those just in case situations.

[cc9874123]

What does the 'I' Stand for in SNIF? SNF, yes, but I've never seen it with an 'I'

HouTX offered very sound advice. If it were me, I probably wouldn't have taken the position, but I was not as confident a new graduate. :) It seems like it would be very difficult to provide leadership, let alone to be the only leader when you are still learning yourself. Hospitals and LTC facilities do not always have the best interest of their staff when filling a role, so be careful. Obtaining your own malpractice insurance is sound advice!

I have never been in a supervisor role, and I have been a nurse for two years. I wish you the best of luck in your position! :)

[amoLucia]

I think OP put the extra letter in there because it sounds out phonetically, like sniff. But there are ICFs - Intermediate Care Facilities.