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What is it really like to be a new graduate nurse????

We as nurse eduators want to make nursing school better.

New grads have told me,we thought we knew what we are "getting into" ...

Now that several months have passed since graduation, does reality compare with what you thought it would be like?

How could your nursing program/hospital better prepared you?

If you had to give one piece of advice to new grads, what would it be?

Any other pearls of wisdom?

Thanks

angel337, MSN, RN

Specializes in Emergency Room.

i think it's great that you brought this topic up. i worked full time in the emergency room and the floor the entire time i was in nursing school and i think my experience as a tech/cna was more valuable clinically than what any nursing school could have prepared me for. nursing school is too ideal, it doesn't let students REALLY see what they will deal with on a day to day basis such as no time to do real patient care, short lunch breaks or none at all, literally running to complete tasks and the overwhelming responsibilty of trying to do the best you can with minimum support. every hospital is different, so i am just going off my experience. i know this sounds horrible, but it is reality for alot of nurses and it takes time to get used to this kind of work, especially if you have no previous patient care experience. my clinical experience at my school was very intense, our instructors let us do any and everything and they talked to us about what it would be like once we graduated. i appreciated that because i know a lot of nursing schools don't do that probably for fear they will scare off too many students. the best advice i would give any new grad or soon to new grad is to get a job in the hospital as a tech or cna to get your feet wet. it will truly open your eyes to what lies ahead and when it comes time to tackle the actual nursing job, it won't be so difficult. i like being a nurse so far, but i am positive that if it wasn't for my previous experience i probably wouldn't feel this way. good luck to all future RN's! you can do it :)

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I'm not sure my nursing school could have better prepared me. I feel they did a good job. I appreciate learning the ideal way and the correct way. So I'm probably not going to be of any help.

If I have one piece of advice to the new grad, it would be to honestly say that first year is going to be tough. You're going to feel overwhelmed, have self-doubts questioning yourself if you can handle it, be disorganized, etc. etc. The point being that with time you eventually get your grove, get your skills, get a little more organized and start feeling confident and better about yourself.

Perhaps, maybe there is one thing I can offer as advice to nursing schools and that is to somehow foster a bit more confidence and self-esteem, while keeping them on their toes so as not to make mistakes. So many schools and instructors seem to squash it.

wow....I remember those first days and I still thank God I had a great boss who was more than happy to teach.

Nursing clinicals do very little to prepare a new nurse..they are too short , too controlled way too organized...too much time is spent in mini conferences with the instructor grilling and not enough time is spent actually providing nursing care.

I can remember the first term making beds and giving one bath..what a complete and utter waste of time...weeks spent worrying about a ridiculous hospital corner and the proper way to hold a washcloth...way too much emphasis placed on commen sense stuff and an insult to intelligent people..

No time spent on moving people ..in and out of bed..around the bed...how do you bathe properly, wash hair and change the sheets in 15 minutes or less..that would be something to practice over and over again since your whole career is going to revolve around bathing,moving,lifting.....making beds for weeks and then giving one bath...not gonna cut it.

Meds...meds and more meds training..don't wait for second term..start early and often...meds every clinical day..this is the biggest area of errors in the nursing profession...nursing school needs to indoctrinate safe meds....the only way to do it is to DO IT...not just one day or one week...every year every clinical...meds meds meds

Scrap some of the neverending ethics classes...teach ethics on the floor...real world ethical and moral debates when they occur...ethics in action with patients,nurses,doctors and families

How about teaching nurses the reality of working with doctors....prepare them for that moment when a doctor hangs up the phone or patronizes you in front of your peers or yells , throws things or calls you names.

How about teaching nurses about other nurses and that they won't be thrilled to see you because it means more work and they don't trust you...

Nursing school is a fairy land where all you have to do is make sure your clinical instructor likes you even if she is a psychpath and you have to tell her everyday she is God's gift to nursing to do it...and I had more than one of those. It was good practice for nurse managers...maybe you should also cover them too...they are not your friends...the union is your friend..your manager is the enemy, don't be shocked when they pretend to be your friend while cheerfully complaining about you to everyone they meet, they are masters of the passive aggressive.

If new nurses understood the realities they wouldn't get so upset...knowing your reality means you can prepare for it and get over it quickly and move on...it can be considered a nuisance instead of a devastation of ego.

Nursing students need real world experience...sitting in a class room practicing putting in a catheter is a complete waste of time.......noone looks like that plastic groin...instructors should be agressively proactive on the unit..every catheter should be a learning experience...be like docs...see one do one teach one..skip the neverending six week how to do a dressing...find a patient and show..teach on a real wound...show how to clean..tape...where to put your dressing tray when there is a lunch tray and nine paperbacks and three flower vases taking up all available room.

Real world teaching over and over and over so it becomes memory..all nervousness gone because you have done it a hundred times on a real person.

Stop wasting time on the "perfect" dressing change that must be graded and critiqued...concentrate on hand washing and how to use sterile gloves...this ridiculous concentration on sterile technique is just an intimidation tactic that freaks out students......try to remember the patient is NOT sterile...good handwashing technique is the answer to a multitude of sins....if you break sterility with filthy hands? bad news..but if your hands are clean or even better clean with sterile gloves on?..well everyone can relax.

Emphasize errors will be made but if your hands are clean the end of the world can be averted.

Use common sense. avoid scare tactics...explain why things are important without invoking terror tactics...teach ORGANIZATION...how to plan your day..how to de stress and how to let the unimportant things go for another day

Good handwashing..being organized , excellent med skills and being good and fast at giving a bedbath will make a new grads life a lot easier.

jeepgirl, LPN, NP

Specializes in Pediatrics, Nursing Education.

it really really sucks.

reality shock at it's greatest.

I also agree that this is a great topic and kudos for you for actually caring to ask!

Something to focus on more in school is organization. The skills section of school is necessary for someone without general nursing knowledge. Increasing the number of patients taken care of in clinical is a plus because you learn that one patient needs this med now and the other patient will need this antibiotic in one hour so you must plan ahead and use time management. Instead of spending endless hours on nursing care plans and nursing theory (sorry but I do not find this aspect practical) the students can then research the primary diagnosis, meds due and the purpose of tests and lab work. I wish I would have had a better grasp on the actual disease process rather than looking up countless nursing diagnoses. I find I do more hard core research now that I'm a floor nurse on a busy med-surg floor. I take the time to look up necessary labs and correlate them with what they tell me about my patient. I research the diagnosis and find the reason behind the CT or MRI. Not enough time is spent truly teaching "connect the dots" in school. Too many random points being made and preached upon. A beneficial clinical would be one where each student planned their day according to meds, procedures, lab work, etc and had a dedicated nursing instructor to simply allow open discussion of the patient's diagnosis and care. No pressure to know all the answers but a real open forum to discuss and learn from other students and nurses.

I hope this helps, I wish it were my former college asking this question. You are a credit to your program.

JacelRN

I agree that it is great that you care and take the time to ask.

I also agree with JacelRN on "connecting the dots". In school, we spent hours upon hours designing care plans and creating nursing diagnoses. In the real world, I pick a care design from a selection and voila - everything is created. It certainly doesn't merit the time and energy we placed on it in school. What does merit time and energy is the pathophys of it all and making all the random ideas connect. We should have had lots and lots of time on the usual suspects - GI bleed, CABG/heart disease, CVAs, DKA/diabetes, trauma/GSW/MVA, resp distress/ABGs, etc. etc. What might happen with these pathologies? why?, what are you watching for? what are you going to do about it?

We also spent waaaay too much time on community health and psych nursing. Yes, I believe we should teach these -- but with not a single grad in my class entering into either field, weeks of clinicals in these specialities seems like wasted time. I'd not placed a single Foley when I graduated, I'd not ever done an ABG stick, I'd only done 3 IV sticks -- yet I spent hours with teen mothers in a group home teaching about proper nutrition for their children.

Teaching should include some of things mentioned above -- how are you going to handle a doctor who yells and belittles you? how are you going to handle the stress of a patient coding on your shift? how are you going to deal with the backbiting and sniping in this field? and how will you rise above it? I had one "renegade" teacher who, out of her own pocket, paid to have a group of healing arts students come in to her class during finals week and give chair massage to every student. Afterward, she drove home the point that we, as nurses, absolutely must find the healthy way we could deal with stress whether it be exercise, massage, yoga, prayer, etc. We pledged to spend a certain amount (each of us decided) out of each paycheck on ourselves -- even if it was $10 for an excellent tube of hand cream.

You ask if we could give one piece of advice for new grads, what would it be.... I have two pieces:

- Get a small pocket-sized notebook (or Palm) and take notes -- what color tube does an ionized Ca++ lab go into, what is a normal CVP, which doctor wants to know if urine output drops below 100cc/hr, when does Lantis peak, etc. I've been a nurse for 6 mths and my notebook is full and well-worn already.

- There is a difference between confidence and arrogance. You need confidence and veteran nurses will appreciate confidence. However, if you are arrogant, you will make mistakes and be eaten alive by your colleagues. You should always be confident enough to say "I don't know how to do this, can you show me" and never be so arrogant to think "I can just figure out how to do this on my own".

memphispanda, RN

Specializes in Med-Surg.

Organization was a big problem for me for the first several months...

I was constantly having to run up the hall to get a bag of IV fluids, to get some saline, to get dressing supplies, etc. I wasted a lot of time doing that and was constantly behind, stressed to the max, and terrified of making a mistake. Even got a really bad comment from a patient because I had to make so many trips in and out of her room.

Another area of difficulty that I am still working on is report. How do I get across all the important information without taking 45 minutes to do it? I am not even sure it is possible when I have 7-8 patients, especially if one or two are new admits or if there were problems during the night. I think report should be observed every clinical day just so you start to pick up on what info has to be told. I think report should be practiced in a realistic way in clinical groups...we had these longs drawn out discussions about patients, which was good for learning about what the pt was going through and why we were doing what we were doing, but we never worked on giving report. The last semester when we had 3 8.5 hour clinical days, we should have spent an hour of clinical time that Friday giving a short report on our patients to our group--then we would have had a much better chance of learning how to do it right.

I wasn't prepared for the crabby, witchy, horrible nurses who will find something to complain about regardless of how hard you have tried to get it all right and get it all done. I had to really grow a backbone and start standing up for myself, but it still happens and shouldn't. One reason I chose to work nights is we don't have any of those grouchy ole bats on my shift, but I still have to give report to a few of them. Just yesterday I got verbally attacked by one of them over a urine specimen that hadn't been taken to the lab--it had been collected, and it was with the things that were to go on the lab run. We were short staffed, and I was planning to take all the lab specimens to the lab myself but before I could I got called to a room "mama can't breathe" and really, mama couldn't breathe. So instead of taking urine to the lab I started working on getting mama to breathe. Still got my butt chewed over the urine--they didn't teach us that came before the ABCs.

Anyway, I think a lot of role-playing in class or clinical would help. I know it sounds hokey, and some students probably would be very uncomfortable, but especially in the last couple of semesters when people know each other better, I think it would help. At least you would have some sort of a plan for certain situations instead of getting run over, behind, etc.

Our newest crew has voiced opinions about this! The most common things that they say wished they had learned were: Team building ( collaboration and delegation) and conflict resolution (how to deal with the Irate, callous and/or rude co-workers and physicians!)

The one thing that bugged me the most about nursing school was that in order to pass clinical, all you had to be able to do was write a good paper/care plan every week. It didn't matter if you couldn't do a proper assessment (did anyone every have an instructor watch them do an actual assessment....I know I didn't), give meds properly, do dressing changes, etc...it was all about the paperwork!

Havin' A Party!, ASN, RN

Specializes in ICU, CM, Geriatrics, Management.

WOW!

What an info-packed thread.

Much appreciated folks!

Gosh,

This thread was a real eye opener. Reading other threads I would see bits and pieces of these situations but to read them all in one place has put down right fear into me! It's good to be forewarned. On the other hand, couldn't there be some way to truly remedy these situations? I'm just starting pre-req's this fall and am wondering if I might be going down the wrong road. I never did have a lot of backbone when it came to confrontation and it sounds like it is the norm. To think that seasoned nurses treat newbies as they do is a down right shame. You would think they would be grateful that they might have relief with more nurses on staff once they get their degree.

I would have also thought that those things mentioned that weren't taught in school SHOULD be taught in school to better prepare for the real nursing scene.

Isn't there any way things could be changed so that the educators can train in a more productive manor all over the USA? Can't nurses band together and say something to the ANA or something? It would be in everyones best interest if training were done on a more logical mannor.

I would think those seasoned nurses would be grateful too, and maybe more kind, if they knew the new staff coming in were more prepared instead of thinking "oh, here comes another green nurse".

Just an excellent thread. Thanks!

I really apprecaite all the input from new nurses in this thread. I understand the passion around what you are saying. Sounds like most are in med-surg. I am a maternal-child (L&D) instructor looking to change things, but it is difficult to buck the tradition. You all have good suggestions, keep it up, it gives me encouragement to keep trying to innovate and change.

It is interesting that psych and community health nursing is mentioned. Guess I am one of the minority who are actually in these areas. Guess it would be idea if we can rotate through all the areas on a minimum basis to get a feel. Then have the choice to spend extra time in a few potential areas we are interested in and get lots of good experience in them.

This thread has been very very informative. Thanks.

-Dan

pgrsctrn2be

Specializes in LTC, office, home health.

I think stress the careplans less and the verbal interactions with the doctors, and other departments in the hospital setting would have helped me more. Also I would like to see the students teamed with nurses on the floor working a patient load instead of just one or two patients per student. The shock of taking 5-7 or more patients is pretty overwhelming to a new grad. I have the chance to see my clinical intructor often now (working in the same hospital now) and after talking to her last week about this same topic, she is working with the school to try and change her clinical for the fall. Hope this will work out, I really think next years grads will not be as stuned when they go to work if it can be changed.

I look back at what college was like and there's many things I would change about it. For one thing, when it came to clinical rotations, we had to choose between doing paeds or obs, and yet it was required that we complete a community rotation. I think the psych rotation was important, that's how I learned I don't make a great psych nurse. But I think it was important to do both obs and paeds because they are very different, and community could have been done in one week really, because in the community we really weren't doing much, mostly observing.

Before graduating from college, we had to complete a pregrad rotation, which was four months fulltime, no classes, just real work one on one with an experienced nurse. I liked that because we were able to put our focus on the specific area of nursing that we hoped to work in upon graduating.

Nursing school seemed to emphasize this fantasy land we were going to be working in instead of focusing on the reality of it all. They're teaching us to be honest professionals, while they're lying to us about what it's really like out there. It's just not right.

Im not a new nurse, but I do remember my first year out of school. I wish I had been given a class on legal aspects of nursing. Lawsuits are such a BIG part of healthcare today. Ive just picked up bits and pieces along the way.

Also, I think every nursing student should be required to work in a health care setting pryor to graduation. We werent required to- but they strongly encouraged us to get a job our last year of nursing school. There are certain thing that you're only going to learn on the job.

moia, I think your comments are excellent and right on the mark!

JacelRN, you made a great suggestion and I see significant value in your proposed approach. It makes so much sense and would be far more interesting to the student.

Thanks for asking!

Although I am not a new grad (I'm halfway through a program). here's what I can say so far:

1. Lose the weeks and weeks of bed baths. After 3 or 4 weeks of baths and bedmaking, I think we can move on. My program gave us a whole term of this, which I think was a waste of time. Their rationale was that we can do a thorough assessment. That sounds good, except that we didn't have the Health Assessment class until the following term.

2. Start giving meds and injections as soon as possible.

3. Don't yell at students who are doing sterile procedures. It doesn't help our learning, and frankly, I doubt the patient will die if my hand happens to move over the sterile field. (not touching it, just above it). Remember how hard it is to grow bacteria in Microbiology class?

4. Let us do more procedures, less care plans. The care plan is overused and every nurse I know says they are totally unhelpful.

Thanks for listening!

Oldiebutgoodie

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