Realistic Expectations!!

llg, PhD, RN · Jan 5, 2008

For salary information, you will need to check with local employers to get a good sense for the range in your area. Salaries vary widely from place to place -- and there is no way to tell from your post where you are from. For example, salaries in New York City and San Fransisco are WAY, WAY higher than they are in small town in the south and mid-west. But typically, full-time work in nursing provides for an average, middle-class lifestyle within your community. You'll not be rich, but you won't be poor, either.

As far as on-the-job training and mentorship, that also varies widely. Some employers provide extensive training and others do not. For example, at my hosptial, a new grad gets 10-20 weeks of formal orientation and preceptorship, depending on the specific clinical area. Mentors are assigned for a few months beyond that period to serve as an advisor and coach for the new grad. However, you will find other employers who only provde 2 or 3 weeks of formal orientation and/or have longer programs, but run them badly.

The more flexilbe you are ... the greater chance you will have of finding a good job with a good employer. There are good jobs and good employers out there, but they might not be right down the road from your house. If you can not be flexible, you will have to settle for whatever your local employers provide -- and to find out what your local employers provide, you'll have to talk with local people who know that information.

K98 · Jan 13, 2008

The first year is a tough one. I started in an ICU, and was ready to call it a day shortly after I was off of orientation. It is an extremely busy unit with plenty of cardiovascular surgeries and an aggressive transplant program. The high patient acuity can be stressful, but so can being a new employee. We are oriented to the bedside, but not to work rules, call-off lists, pull lists, etc.. A lot of this stuff can generate some nasty surprises for the new nurse. The second year is much easier, if you make it through the first. I'm glad that I didn't pack it in, as two years of SICU experience has opened more than a few doors for me. Best of luck to you.

wazeout · Jan 18, 2008

Thanks for the feed back! I just wanted to hear from some of you out in the field for some honest scenarios. I'll be attending nursing school hopefully this fall or winter '09 and wanted to know what to expect. I live in the Seattle area but don't mind relocating if I have to, but, that is still some time away before I'd have to make them type of decisions.

No, I would not expect for it to be a walk in the park but at the same time I would expect a facility to have some sort of honeymoon period for graduating nurses. Like I said clinicals are definitely helpful but only as a model for the real thing. Anyway thanks for the replies.

Thank you

Wazeout

" Our will is always for our own good, but we do not always see what that is; the PEOPLE is never corrupted, but it is often deceived, and on such occasions does it seem to will what is bad." ( Rousseau: Social Contract)

nursemike, ASN, RN · Jan 18, 2008

The First Year in Nursing forum has lots of stories about the "honeymoon" period. Hmmm. Honeymoon? Maybe, if you married a paranoid schizophrenic, with continuous PMS...

But I exaggerate...a little. It's hard. If you don't work your butt off, you probably won't make it. As you surmised, school is what prepares you for learning to be a nurse. It's important, because a lot of the factual information does come back to you when you need it, but most of the skills are learned OJT. These days, a lot of students are lucky if they get to start 1-2 real IVs in school, or drop an NG tube. You do some of these things in labs--my school even had a computer simulation for IVs--but it isn't much like the real thing. You only get the "feel" for it on live patients.

But, as everyone says, those manual skills aren't the important part. They're mechanical (sort of) and will come with practice. What you really have to work at is time management with a full patient load, and dealing with patients who haven't actually read the textbook, so they have ways of doing things they aren't supposed to. Climbing out of bed and running down the halls, naked, for example. You actually do use the nursing process in situations like that, but it tends to go really quickly.

The saving grace is that you generally aren't thrown to the wolves right away. You orient with an experienced nurse who has dealt with the same situations in realtime, and if you're in a good place, charge nurses consider your skills when they make assignments. And, again, if you're in a decent environment, there's a degree of forgiveness for being new. People typically aren't looking to report you to the BON for an honest mistake. If you are conscientious and diligent, your first med error probably won't end your career. Probably--because your first med error can kill, so you really need to be aiming for perfection, even though it's a target you aren't likely to hit.

The best thing I ever heard was a nurse talking about her orientee on a smoke break. She said she could teach everything but work ethic. Her orientee wasn't the sharpest knife in the drawer, but she showed up every shift and worked hard the entire shift, paid attention to what she was taught, and didn't make the same mistake twice. That's the kind of newbie who makes a good nurse. Book smart is good, but you need common sense, willingness to work, repsect for your pts and your peers, and the ability to keep coming back for more. Even the best nurses have shifts where anything that can go wrong, does. Nurses are the ones who still show up the next day.

And, boy howdy, does it feel good when you finally get to the point that, more often than not, you decide how the shift is going to go.

There will be times when a patient crashes and there's nothing anyone can do, but eventually, there will be times when a patient is trying to crash and you just won't let them. (Also plenty of times when you clock in, do your job, and clock out. It isn't always high drama. A lot of times, it's getting meds passed, maybe a dressing change or two, and filling out paperwork. Personally, I like it when the biggest emergency of the night is a prn BP med and all God's children are safe in their beds.