It’s truly amazing how quickly time flies by, it feels like just yesterday I barfed in the bathroom of the building I took the NCLEX in only to find out three days later that I passed and was an official “registered nurse”. Hannah Josephson, RN. Wow that sounds so cool I said, and off I was to my first job, as a new graduate nurse just like that. That was two and a half years ago now, but who’s counting? Compared to many nurses, this is just a blink of an eye, I am still a new nurse and I still have many years of nursing ahead of me and I know that. But what I also know, is that there is a wealth of knowledge that I have gained in just these past 30 months. So here it goes, here is what I have learned and this is my advice to you…
1. Get a good pair of shoes: Let me tell you, you will be on your feet more than you will be off of them, and one of the most important things you can do for yourself is get a pair of truly comfortable shoes. Don’t get dansko clogs just because “every nurse has them” if they are not comfortable to you. If you aren’t wearing the right shoes, your feet will hurt, your back will hurt, heck your whole body will hurt. Find something that you feel comfortable walking miles around in, because you likely will be walking miles per shift (wear a pedometer I dare you). See what your hospital/floor policy is, but if you can wear a pair of comfortable sneakers, that may be your best bet. I personally like the XP Danskos because I feel they have a little extra padding, plus they give me some height so I don’t look as short, but honestly after a few hours, my arches hurt, my back hurts and I have probably rolled my ankle at LEAST 10 times (seriously, I cant be the only one who does this right?).
2. Don’t show up on time, show up early. When you are first starting out, you will be so overwhelmed just going to work, especially when you are off of orientation. I remember some days I was so scared and nervous to go in that I would think to myself “well it wouldn’t be so bad if I slipped and fell down these icy stairs, that way I would miss work”. It’s embarrassing, but it is true and I know other new nurses who felt the same way as me. It is scary because as a nurse you assume so much responsibility, literally peoples’ lives are in YOUR hands. As a new nurse, this responsibility plus all the other things you are supposed to remember become a huge burden. Make sure you take the extra time to show up early for work. I’m not saying an hour early but like 15-20 minutes early so that you can settle yourself down, get your assignment, organize yourself and at least try to relax before you find yourself feeling rushed to take report. Trust me, I used to only give myself 5 minutes to get ready before a shift and I would feel so frazzled, unprepared, unorganized and anxious which is not a good or safe way to start a shift. It is worth the extra 20 minutes of your time for your sanity and your patient’s safety.
3. You are NOT the only nurse working. ASK FOR HELP. Seriously, I think I still have an issue with this one. In nursing school, they talk about delegation and delegating this or that and asking for help, but in clinical rotations during nursing school they make you do everything. Somehow this instills into our brains that we, as nurses, must. do. everything. NO, it is not humanly possible. Asking for help doesn’t mean that you aren’t capable of doing something, and any good nurse/colleague/co-worker will understand that and even appreciate you for realizing the need to ask for help. If it is something that can be delegated to an aide, delegate it to them- after all that is their job! I used to be paranoid that if I asked for help from an aide that they would dislike me for using them or that they wouldn’t get the job done as quickly as I could… but I soon came to find out that when done correctly, delegating can be a huge huge help with my workflow. A lot of times other nurses will not come forward and offer help because they assume that you will ask if you need it, so never be afraid to ask for help, ever. And when someone asks you for help, return the favor if you can.
4. You are NOT a computer. I repeat, you are not a computer or robot. You do not have to memorize every single thing you learned in nursing school. You are not expected to know every single lab value range, or medication name/dosage/indication, it is not humanly possible. LOOK THINGS UP. SO many errors happen when people take random guesses or don’t ask a question when they are unsure of something. If you are unfamiliar with a medication, look it up, ask someone, call the pharmacy. Use your resources! There are so many of them. I will never pretend that I know what something is if I don’t because a) I don’t want to look stupid if asked to explain b) I could do serious harm to someone if I did. I know I am not some einstein genius, and I am not required to be. As a nurse I need to use my critical thinking skills to solve problems and evaluate and intervene when necessary. If you are unsure of an order, question that order. If you are unsure of anything, question it. Because in the end, do you want to be the nurse who overlooked something because you thought you knew it or do you want to be the nurse that catches the medication error that saves a patient’s life?
5. Follow your gut. I know they say this a lot in nursing school, and it really did take some time for this to become a thing for me (like probably within the past 6 months). Once you start to get into the groove of things, you just know certain things. If you have a bad feeling about something, something just doesn’t add up or seem right, let someone know. It could be the charge nurse, another nurse on the unit, a physician or pharmacist, just let someone know your concern, and back up your concern. I work in maternity, and I can’t tell you how many times I have had a hunch or bad feeling about something and had people respond “its fine, dont worry” and then it ends up not being fine. Don’t back down if you truly believe something is going on. Trust your gut, trust your patient. I had a woman recently who was status post magnesium for 24 hours after delivering her baby for severe preeclampsia. When I assumed care of her, she was on a 400mg BID dose of a blood pressure medication ,Labetolol. In report that I received, she was doing much better, feeling better, having no symptoms and her BPs were stabilizing. When I actually SAW the patient, it was a different story. She was sweating in bed, holding her hand to head complaining of the worst headache of her life, dizziness and shortness of breath. Immediately I elevated her head of the bed and took her vital signs. All of which were normal (including her O2 sat) minus her BP which was 140s/80s. The MD was notified and satisfied with BP but wanted a repeat, which ended up being around the same if not higher and the patient was still not feeling well. I felt like I was “bothering” the doctor for keeping her posted on the play-by-play of this patient, but looking back I don’t regret it for a minute because this patient was really deteriorating right before me and needed more intense monitoring than what could have been done on our floor. Long story short, she ended up being transferred to another floor where she received loads and loads of IV blood pressure medication to help stabilize her blood pressures. When I heard how much medication she had gotten on the other floor, I just KNEW that this would be the case from the first moment I saw her in bed, she just looked awful. I remember I even suggested to the MD that this patient may need more monitoring than we can offer, but the suggestion was politely declined at the time. I did not stop contacting this doctor with all the details because I had this gut feeling that something needed to be done with this patient, and I am really glad that I handled it the way I did because I hate to think of what could have happened if it had gone unnoticed throughout the night- she could have had a seizure, thrown a clot, had a stroke or MI…. This is just one example, there are so so so many. follow your gut. If you are wrong, you’ve probably done no harm but be extra cautious, but if you are right, you’re doing your job.
6. You may get eaten alive by some older nurses but you cannot take it personally. For some reason, nurses like to “eat their young”. I don’t know if it is for the sheer fact that they don’t remember what it was like when they were new, or if it is a secret nursing hazing ritual, but you will come across some nurses who will just try to bully you around and scare you. Please try not to let it get to you. Just do your job, be a good nurse, and that alone should prove your competency. Easier said than done, but don’t feed into this mentality, and don’t treat the new nurses after you like this. I always offer a helping hand and advice because I remember being in those shoes not too long ago and I wished that I had someone that I could go to for advice.
7. Bring snacks. You may not always get a full lunch break, but that doesn’t mean you should not eat. Nursing is hard labor and you will be running around for hours at a time before sitting down. A lot of time, nurses go without getting a proper lunch break, I can attest to this. Bring granola bars, yogurt, a water bottle, anything really to munch on when you get a chance because if you don’t get to take your lunch, you may get cranky or even feel sick/lightheaded/nauseous. At the very least, drink water. I’m still very bad at this.. I sometimes don’t sit down for hours to have a sip of water or a snack, but make it habit, sometimes you have to put yourself first. You can’t take care of someone else if you can’t take care of yourself first. Oh and don’t forget to pee! Seriously, you’ll get a UTI if you hold it in all shift. You make your patients void, so practice what you preach!!
8. Document document document. I remember a professor I had in undergrad say “If it isn’t documented, you didn’t do it“. Nursing can be so fast paced that it is easy to forget some things, or something may seem more important than something else. Or maybe you thought that baby’s respiratory rate was 77 but you don’t want to document that because then you have to recheck it in an hour and it was probably a mistake right? WRONG. document it, recheck it. It could be nothing, but it could be something. what if you found out that baby started grunting/flaring/retracting and became apneic on the next shift and had to go to the NICU because nobody had noticed ( errhm documented) that the baby was tachypneic. Again just an example. Somethings do NOT get documented (ie: “husband is a pain in the ass”), hahaha, but that goes without saying. There are some things that get passed along in nurse-to-nurse report, but remember, this can lead to error, misunderstanding, and may forget to get passed on again. Make sure you document everything thoroughly, objectively and as brief as possible. I always think to myself, If this had to go to court, how would it look? Document what you are concerned about, document your intervention, document who you made aware, document their reaction. Because in the end, it is your license to protect, and your patient’s lives in your hands. Nursing bears a huge responsibility.
9. You will go home and stress about all the things “you may have forgotten”. trust me this is NORMAL. I used to call my floor and ask to speak with nurse X or nurse Y and make sure that I documented this or signed off that…etc. Talk about paranoia. This can seriously drive you crazy. There would be times I couldn’t sleep at night because I was just trying to remember if I did everything right at work and if I documented it all, if there was ANYTHING I forgot. It is normal in the beginining but try not to make a habit out of it, that is no way to live. Eventually, you have to leave work at work or you will burn yourself out HARD and fast. Trust me, if something was missed or you forgot to document that oxycodone, someone will call you. It is totally normal to be hard on yourself, and alot of that makes for a good nurse, but when you take it to straight panic level, you may have a lot bigger of a problem on your hands than you thought.
10. Not every patient is going to love you, even though you want them to. Even though you may have done SO much for them, and felt like you were the best possible nurse, you are not guaranteed that your patient will be outright loving of you or grateful for you. This is the hard part because a lot of us nurses are overachievers and strive for excellence and thrive off of being a patient’s “favorite nurse”. There really is nothing like building a good repoire with a patient and feeling like you made a difference in their hospital stay, but that is not always the case. Humans are interesting in that we all experience things differently, we all have different stressors and things going on, we all experience pain and joy and love in different ways. You cannot take it personally if a patient doesn’t seem to love you as their nurse, you just can’t. I have spent so much time wondering “why don’t they like me, I have been so nice?”. Well, because to them, I am part of a negative experience for them, where they are in pain and not feeling well and they don’t want to do small talk, they want to be alone. Some people are not lovey-dovey, some people are not as grateful… that is just life. Just go into it telling yourself that you are going to be the best nurse that you can be no matter what. We don’t really know what is going on in each of our patients lives or what is going through each and every one of their minds. And quite frankly, our jobs are to help them heal, not to become their friends. I personally feel like I have connected with so many of my patients and I have felt their gratitude, kindness and companionship, but there are some patients where no matter what, I can’t seem to connect. I have learned to just let it go. As long as I am providing the best care that I can and attending to that patient’s needs, I cannot be selfish and insist to myself that I am their favorite nurse.
11. Don’t overshare personal stories with patients. I have heard some nurses share some real personal stories with their patients. It’s okay to be personable with your patients, but take it with a grain of salt, use your judgement. Don’t say anything that will hinder your patient’s trust in you and don’t make it about YOU, because the patient is the patient at the end of the day, and they want/need it to be about them.
12. Don’t assume anything. Pretty obvious one here. If an emergency bell is going off, don’t just assume someone has gone to answer it, take responsibility. If a patient is walking around clueless in the hall, don’t just ignore them and assume they will make it back to where they came from. Be helpful, don’t assume, ask questions.
13. Don’t forget to say goodbye to your patients at the end of your shift. I mean, I think this is just common courtesy here. I can’t believe that some nurses just leave without telling their patient that their shift is ending/asking if they need anything in the mean time. Just make it a habit to go say goodbye. I spoke with a nurse who told me she used to feel awkward doing this, but once she started, she couldn’t imagine not saying goodbye to her patients. I really didn’t know that people struggled with this until I started my most recent travel assignment. Obviously, don’t wake the patient up if they are sleeping, but I think in general, it is courteous and kind to say goodbye to your patient after spending a solid 8-12 hours with them.
14. Don’t pick up too much OT. It may be tempting, especially at first to make all that extra money, but don’t overdo it. You will learn to resent your job, resent wanting to go into work and you will become burnt out. You will feel like a zombie/robot that is just on repeat mode and you will make mistakes. Realize when you get to the point that you dread going into work, because at that point it’s safe to say you are probably burnt out or well on your way to getting there.
15. Don’t talk smack about your co-workers. It isn’t nice, it helps noone, it doesn’t create a conducive work environment. We aren’t in middle school, we are all professionals and should support a professional, judgement-free work environment. I don’t want to find out someone is talking behind my back, that is hurtful. If I have done something to bother someone, I would rather them come to me directly. Take that into your practice. If it bothers you that Nurse A always does xyz, take it up with Nurse A, don’t go telling everyone else about it- that is gossip. It will get back to Nurse A, it will cause office drama, and really, who wants that? Just be kind.
16. Be thankful. Sometimes I complain about my job, but at the end of the day I am thankful that I have a job- a job that I love, a well respected and well paying job. I get to do my job with passion, work with amazing people and help build families and learn something new every single day. How many people can say that?
17. You will make some of your best friends/lifelong friends ever at your job. Or as I like to call them, my work wives. These are my people, they have my back & I love knowing that when I get to go into work, I get to spend time with them. They help support me when I am down, help me laugh when I am sad, help me bear the weight of a heavy assignment and much more. They are my friends outside of work too, which is equally as important. I love my work wives and wouldn’t be able to do my job without them!
some of my work wives & I (Sarah, you are here in spirit I promise!)
18. DO USE caution with social media! This is a really important one. In this day and age, everyone is connected to their phones which are connected to twitter, instagram, facebook,etc but it is important that as a nurse you leave all that behind. It is not wise to post about patients or your day at work, even if you are leaving out “identifying factors” because someone is bound to see it, someone could get offended, it could get to management. Is that one post really worth risking your job? I have been astounded at what some people do on social media- I have seen people take photos of babies/patients and post them- THIS IS AGAINST THE LAW, you will get in trouble. Just be smart about it. I have posted before things like ” Rough day at work, I am thankful for all of my awesome coworkers”- I think that is fine, and I think you have to use your judgement because it could easily not be fine. Don’t post about how you don’t like your coworkers, or how your assignment was awful, or how unsafe staffing was (if this is the case, take it up in the appropriate outlet, not on social media, if a patient sees this it could open a can of worms). Don’t post things that you are doing if you call out of work! common sense people… I mean I really have seen it all and it amazes me what some people think is okay to post on social media. Is a like or a comment worth it that much that you risk your job to post it? Also, use caution when adding patients as friends on social media sites- this one is a touchy subject. I have a couple of really close patients that I had for extended periods of time that I added/accepted only after I was done caring for them, and I am able to keep up with their growing miracle babies and help give them words of encouragement. Again, I think this is okay, but it is a slippery slop and you have to be really careful with social media in this day and age!
Does anyone have some words of wisdom/advice that they would like to share?