For newly minted nurses, the first year of independent practice can be nerve-wracking and overwhelming. New nurses are suddenly responsible for patient safety and well-being while being without a clinical instructor or preceptor present to check their every move. The gravity of the catastrophic consequences that can occur from just one subtle mistake settles in. Most nurses also undergo a period of culture shock, realizing that textbook nursing and actual day-to-day practice are vastly different.
The band Maroon 5 released their hit song “Harder to Breathe” the year before I graduated from nursing school. I was haunted by the now-famous line “Is there anyone out there, ‘cause it’s getting harder and harder to breathe.” My nervous mind conjured up images of a patient in respiratory distress, and me, their nurse, either stretched too thin to notice their plight or too inexperienced to act prudently.
After reflecting upon my own time as a rookie nurse, and soliciting the opinions of other fellow nurses, I came up with a few key things to remember when interacting with students, new grads, and new hires to a nursing unit.
1. Be present and engaged.
There is little worse for a new nurse than working with a preceptor who quite frankly would rather not be bothered with their presence. A reluctant preceptor is going to be ineffective, and the orientee will learn little more than discouragement. As a preceptor, be warm, approachable, and let your preceptee know you are glad they are there. When undertaking a new long-term nursing student or orientee, I would meet with them a few minutes ahead of our first shift together so we could become acquainted. I wanted them to know that I was excited to have them with me. The most important thing I asked of them was that they be open with me about their learning experience. I wanted them to feel free to tell me if they were not understanding what I was trying to teach them or if something was lacking in our time together.
2. Teach the “unspoken rules” of your daily routine.
Nursing schools teach the basic foundations of pathophysiology, pharmacology, nursing assessment and intervention, and essential hands-on nursing skills. Nursing schools do not teach how to navigate working in a new nursing job.
Each unit has its own culture and unwritten rules. For example, “Our pharmacist is the best resource we have for this medication,” “X physician group is managing this part of this patient’s care, and Y group is managing everything else,” or “Don’t approach the unit secretary until after she’s had her first cup of coffee.”
3. Maintain consistent preceptors.
It can be unsettling for a new hire (especially a nurse with no prior experience) to work with multiple preceptors during their orientation time. It is best to limit them to one or two preceptors. A nurse who has a new preceptor every shift has no foundation to build on. An established preceptor knows what the orientee is capable of and will tailor each day accordingly. A newer RN may feel left in the lurch by a preceptor who overestimates the rookie’s abilities. They may feel confused when they are taught conflicting things from different nurses. An experienced RN may feel frustrated by a preceptor who underestimates their abilities. While it is good for a novice to learn from other nurses on the unit, this will come naturally once the preceptee is off orientation. A new nurse will quickly discover by experience which nurses are good at IVs, wound care, pharmaceuticals, quick assessments, or speaking with families and patients, for example.
4. Maintain long-term mentorships.
At the end of orientation, new hires should each be assigned to long-term mentors, preferably associates of their choosing, who can guide and coach them through their first year of practice. A mentor should be someone who is seasoned but not necessarily in an education or leadership role. Someone they can reach out to in confidence when they struggle, which every nurse will do at some point. For all of my long-term students and orientees, I made myself available as a resource any time they needed me, even after our time together was over. I wanted them to know they had a safe place to vent or ask questions when they felt overwhelmed, which they would inevitably feel. I was happy to serve as a job reference for one student who showed great potential as a nurse.
5. We all play a part.
Nursing has an unfortunate, but not undeserved, reputation for being unkind to its young. One of the biggest complaints I hear from new nurses is that they are afraid to ask questions of more experienced nurses because they are made to feel stupid for not knowing the answers.
Every nurse can play a part in helping new team members to feel included and confident, shaping the unit’s culture of inclusiveness and growth. You do not have to be the designated preceptor, educator, or new staff liaison in order to do this. Be approachable. If your patient needs an IV, indwelling urinary catheter, NG tube, or the application of some other skill the learner may be lacking, ask the orientee and their preceptor if they would like an opportunity to try. After their orientation is complete, periodically ask the new nurse how things are going and how they are feeling. Check with them throughout the shift and ask if they need any help. Make sure they feel included in staff meetings and unit social gatherings.
Taking the time to foster new nurses is an investment in your unit. The nurse you guide and teach today will be the nurse you can count on for help when everything on the unit seems to be falling apart the next day.