What do you wish someone would have told you on your first nursing job?

LadyTiger44 · May 22, 2008

I am also a new grad and about to start my first job so I look forward to what people have to say. A great book I found that has some good tips is Your 1st Year as a Nurse by Donna Wilk Cardillo, RN. I got it off of amazon.com for a good price. Good luck!

Penelope_Pitstop, BSN, RN · May 22, 2008

if something seems abnormal to you, it may very well be. don't doubt your assessment.

jess

TrickieTam · May 22, 2008

School only teaches you the basics of nursing! You don't actually learn until after you begin working alone on the clinical floor. 1.5 years later and I am still learning. Good luck with your new career!

jessi1106, BSN, RN · May 22, 2008

I am a new nurse...approaching my first year.

There are countless things I was unprepared for. A couple that come to mind now are...

1) Pts are NOT always appreciative of the care you provide (no matter how hard you try!)

2) dealing with families can be extremely challenging

Burnt Out, ASN, RN · May 22, 2008

I was told no question is ever dumb. So never hesitate to ask questions. If you don't know how to do a procedure, ask your other coworkers and see if they will go with you and watch you do it (while they talk you through it) or see if you can watch them do it.

TiffyRN, BSN, PhD · May 22, 2008

All the advice I saw was great.

My advice is: Don't go out of your way for your hospital. They WILL NOT go out of their way for you.

And understand I'm not an embittered nurse, I truly love what I do; but I have few if no feelings for my employer. Learned better several hospitals ago. I got my feelings hurt really badly before I learned that lesson.

One of the greatest pieces of advice I ever received was from my first and favorite Nurse Manager. She told me when she hired me that she never expected me to know everything, particularly in the beginning. She did however expect me to know what my resources were and to use them. That can be difficult, but find out who you work with has the dead-on assessment skills, the killer IV skills, the ability to read that doc's writing no one else can, the one who can read strips or EKG's, who has peds or L&D experience (if this is not your main area of practice, but you'd be surprised how often those patients migrate to other areas of the hospital).

I have used that advice my entire nursing career.

Rabid Response · May 22, 2008

Oh boy. I'm sure I'll think of more later, but here goes:

1. Do not assume that, just because the nurse you are following has way more experience than you, she will not have made mistakes (maybe even bonehead mistakes). Trust your own assessments of the patients and chart them. Do not assume that everything ordered for the patient has actually been done by the previous nurses. Everyone misses stuff.

2. Follow the orders and not the Kardex or what you hear in report. You may feel like you are wasting time to look up an order, but it will be worth it if you save yourself a world of grief.

3. It's better to be a little bit late giving meds than to make a medication error because you were rushing.

4. It's better to wake a cranky intern in the middle of the night than to have your patient crash because you didn't trust your gut feelings.

4a. Even new nurses are allowed to have gut feelings.

5. Document, document, document! Otherwise, it is only your word against everybody else's. Don't even think of it as charting; think of it as covering your ass.

6. Believe it or not, some day you may actually catch up with all the work you have to do on your shift. You might find yourself ahead of schedule or with a free moment. This is when you should ask your coworkers if they need any help. Offer specifics--do you want me to get your patients' blood sugars? --do you need help moving Mr. Y in room 2? --can I get you anything from the supply room? The next time you need help or to have a question answered, you will notice that coworkers are much more forthcoming.

7. It gets easier.

Good luck!

jodi_cmsrn · May 22, 2008

Remember that even though you read the books in school about what the patient should do or look like because of their diagnosis, the patient has probably not read the books. Trust your instincts or the patient that says "Something isn't right"

shellsgogreen · May 22, 2008

to not assume that all the aides/techs will tell you of abnormal vital signs - check for yourself! i learned this the hard way; a patient had a very low bp, and hadn't mentioned it to me - and this was a very reliable tech who normally did report these things ( everyone can make a mistake) but i learned quick to check anyway.

best of luck to you

kristenncrn · May 22, 2008

Develop a thick skin and learn to shake things off. Really! Take a deep breath and go into the next room.

DO NOT TRUST your boss, your coworkers, your providers, your patients, the therapy dogs (okay, them you can trust) too easily.

Statistically, it will be hardest one year out. Prepare for that. Build up a reserve of positives.

Continuing education is your friend - if your hospital provides free classes, take whatever your schedule allows. Don't look at it as a chore - you're building your confidence and eventually putting money in your bank. Take any class that your management will let you take if it is sounds interesting.

Remember your therapeutic communication class? It's as important (if not more) to practice assertive communication with your providers, your coworkers, your manager - everyone that works with you.

Everyone is scared during a code (I'm in peds - maybe adult ED trauma docs keep an even pulse, but our docs freely admit that they feel fear every time - even in the expected ones.) Everyone. Deep breath. Do your job. Cry later.

"How can I help?" - to the other nurse on the hall, the tech (if you are lucky enough to work with one), the secretary with 20 charts stacked in front of her, your manager... or even the residents on their first day at your hospital as they are trying to find the MD orders - goes a long way.

And echo what everyone else says - trust your gut. Always pause when something just seems off. Listen to the family if they say something is wrong. Be brave enough to call someone for a second opinion saying "I have no clue, but I know something is different... maybe you can figure it out."

Be proud!!!! There are 2.9 million nurses in the US. I can't say that I like all of them, but I think I like about 2.8 myself. Welcome! Consider joining an organization or two once you are comfortable - nursing has very unique challenges - very different than other careers. Figure out what issues are important to you (staffing, public perception, retention, CQI, ethics, diversity....) then help to make it better.

I'm optimistic about nursing's future. But I'm off today. :)

Seriously - welcome. I honestly believe there is no better profession and I wish you the best of luck in your practice.

ddoosier · May 22, 2008

I went straight into the SICU.My favorite preceptor told me, as a newbie, your not expected to know everything. But you are expected to know when something is wrong (Thanks DeAnn) and I immediately relaxed. Talk to other RN's who are a couple of years ahead and find out who are the "go to nurses" on the unit (we have an awesome cardiac nurse on our unit who loves to share knowledge). Be humble and don't come across as a know it all. Bring in food!!!LOL Good luck and I'm sure that down the road, you will become a "go to nurse".