The New Nurse

You finish nursing school, pass the boards, and then you hit the unit running. I know what you’re feeling because I remember those emotions like they were yesterday: excitement, eagerness, pride… lost, ignorant, overwhelmed, unprepared, scared. I can tell you a thousand times that these feelings fade with time, and most of them will. But I found that words of encouragement, while morale boosting, wasn’t always enough to help me through the rougher times early on.

In this post, I’ll share with you the things that helped me through my career early on, and still help me in my career four years on.

Finding a mentor
If your hospital system or unit do not assign you a mentor, find one! Studies have shown that successful mentoring programs have greatly improved both career success as well as increased nurse retention.

Having a mentor give you a safe space to decompress, ask questions, and voice concerns can be therapeutic. A mentor can guide you in unit-based policies and procedures, but can also be a sounding board for nursing plan of care, how to speak with that particular physician, or appropriate nursing care for a patient. A mentor can advocate for you, or help you advocate for yourself. Mentors teach you new skills specific to your specialty, and help you perfect existing skills. Mentors are also excellent for giving that tough love – something I need regularly!

To this day, I have had multiple mentors depending on the situation or job I was meant to do. I had a mentor I spoke to every Monday morning about nursing related tasks, interventions, methods, studies, etc. We discussed ideas to incorporate into our nursing care, time management, and documentation. I would often ask why a doctor would use one treatment over another, or why one intervention worked better than another.

I had a couple other mentors that worked the same shifts as I – these were my safe people during work hours. They helped me through decision-making, speaking to physicians, or how to approach a tough situation with a patient. They were there for me as I cried or laughed. And they helped nurture that critical thinking that is so imperative to nursing. As I begin this new endeavor at a new hospital, I will seek to find these people there.

I also had mentors in leadership, especially as I began to embark on that journey myself. These mentors are excellent when you need that particular advise on how to advocate for your patient to a doctor, or even handling touchy situations between colleagues. They are great for deciding what your next steps in education should be, or how to best approach advancing in the clinical ladder.

As your career and experience advance, you will also find that being a mentor will not only serve another novice nurse, but yourself as well. It helps to solidify all of those wonderful things you’ve learned from your mentors and pass them on to the next generation of new nurses.

At the same time, if you feel that your mentor (assigned or unassigned) isn’t the right fit, seek out your leadership team to make a change, or make that change yourself. A safe space is imperative to your success.

Asking Questions
Having a mentor you can ask questions in a safe place is wonderful, but ask those questions in uncomfortable places too (and of course, when appropriate)! I have learned that most doctors, and nurses, are willing and delighted to help in the learning process. After a situation is stable, approach the attending physician and say, “I noticed that you did X. Could you explain the rationale.”

A question I recently asked at work involved a patient with a migraine unrelated to pre-eclampsia. The physician ordered a medication that I’d not yet used as a treatment for a migraine. I simply stated such, and he happily explained the mechanism of action, studies, and anecdotal evidence. Sure enough, about an hour later, the patient’s migraine was gone.

Other phrases to help assist in asking those questions:
“Could you help me understand…”
“What is the difference between…”
“Could I bounce an idea off of you?”
“I have some questions about the code…”
“How can I improve…”
“What would you do in this situation?”

If you have some other questions that helped you learn, share them in the comments below!

Jump In
The best way to get experience and exposure is to seek out opportunities for learning. Often this means jumping into situations as a helping hand!

In nursing school, I often stood in the back, nervous I’d do something wrong. This was so contradictory to the way in which I learn, though. Placing my hands on those IV pumps, foley catheters, and IV start kits; familiarizing myself with the different supplies, medications, and skills… boosted my confidence in my skill set. I had to push myself to jump into those emergent situations and offer my help in order to learn. You will find that exposure will get you more comfortable being in these situations and knowing what to do next.

I often tell students and my preceptee’s to observe or offer help in deliveries, OR cases, or other situations. I often take them into rooms to play with setting up the beds for deliveries, practicing the steps of inserting a foley catheter, and allow them to start IV’s on me or other willing volunteers. We constantly review perfect and not-so-perfect fetal heart strips and contraction patterns. Before stepping into our assignments, we discuss time management – what’s first/the most important?

Jump in! Experience everything you can! And then…. ask questions!

Make a cheat sheet/notes book
If you’re anything like me, lab values, medication dosages, and phone numbers flee my brain the moment I need them. So how did I counteract this? I made notes in a pocket sized notebook for quick reference. There are also pocket reference guides for the many different specialities in nursing that are already made, however I found writing it down helped me to remember it in the future.

I also found that keeping a binder of often referenced policies came in exceptionally handy for myself and my colleagues. For instance, I appreciated having the labetalol protocol at the bedside while administering the medication. It also assisted in explaining policy to physicians/nurses/midwives. Being able to provide evidence assisted with patient or self advocacy.

Be willing to accept students
I know! Seems crazy because you’re new and what on earth could you show to a student?!

When I was still orienting to Labor and Delivery as a new nurse, my preceptor snagged a student to pair with me. I looked at her like, “what the hell are you thinking?!” But she said, “It will help you to teach what you are learning.”

Oh, was she right! The concept is simple: by teaching others, you solidify what you’ve learned. Why do we turn the mom when the baby is having a variable? Why do babies have lates? Answering the questions that you once asked helps to understand the concepts you are learning and makes those tasks less mindless; it gives them purpose.

Having a student also helped me to better explain to the patient why I was doing particular things. Patients should be involved in their own care, and they’ll want to know why a group of nurses and the doctor just rushed into their room to do a bunch of seemingly random things. It’s your job as the nurse to help mitigate those feelings of unknowing and fear.

Allow for discomfort
My preceptor that oriented me constantly sought out uncomfortable situations or “train wrecks” for me to learn. At the time, I was so frustrated that she did this. But now I appreciate all of those learning opportunities. If your preceptor is not providing you with these opportunities, seek them out! Learn!

It’s scary being part of a code of any kind! To be honest, some nervousness and fear are healthy! However, being part of these uncomfortable situations gives us the experience we need to cope with and prepare us for the next.

Step away from the computer
It was near constant that my preceptor told me to “step away from your comfort zone”: the computer. It was easy to turn to something I knew, without a doubt, that I needed to do: chart. I knew I needed to document the fetal heart rate, the contractions, what time the doctor walked in, what time mom’s water broke, the decelerations in fetal heart rate. That was the easy part! But I was missing out on being involved with my patient’s care. I was missing witnessing the physiology of decelerations in action. I was missing that bond with my patient.

I learned to utilize a running note in short hand during hemorrhages, deliveries, dystocia’s, etc. I learned to document in real time after I completed patient care, and I learned that as soon as I sat down at the nurses station, I needed to put my fingers to the keyboard before other distractions pulled my attention away.

This may be more time consuming at first, but that’s okay! As you develop your own system, you become accustomed to balancing your time between documenting and patient care.

Be open to learning
This kind of encompasses everything above, however I thought it important to mention. Nursing is a profession that evolves constantly. There will always be new practices, policies, and things you simply didn’t know! One of my favorite things about this profession is that I learn something new almost every shift; and that can be anything from a different labor position, pushing technique, or medication, to a newly published best practice.

Remember, that it’s easy to stay stuck in “what you’ve always done,” or “that’s not the way I was taught.” Resist it! Seek to increase your knowledge, but always stay humble! The nurse that “knows everything” becomes the nurse that is dangerous.

Respecting tech’s and housekeeping/Delegation and time management
This is important. You are now a nurse, and you have so-called “authority.” But this doesn’t give you the right to order your techs, housekeeping, etc around. Be cognizant of your delegation and do not abuse it. Being new, this is difficult for some. In the beginning, I had trouble delegating to the OBT’s and PCT’s because I was once them. I knew what it felt like to be abused by the nurses and doctors, and I always told myself that I would never be the same when I became a nurse.

However, you cannot do everything. My preceptor constantly told me to delegate one task or another in order to manage my time more efficiently, especially on those busy days when I had 2 labor patients, or a couple of postpartum/antepartum patients and a labor. This is where prioritizing your tasks, asking for help, and appropriate delegation can really help you manage your time. Be cognizant of the tasks your techs are given: are they appropriate for their scope of practice? are they already in the middle of important tasks for someone else? The techs in my specialty are often OR techs as well, so they are not always available to help because they are tied up in a case.

Be understanding of your colleagues jobs. I know this can be hard at times when the unit is busy, short staffed, or has a code happening. It’s easy to become short tempered when we are stressed. Trust me, I know this from personal experience! What’s important is that we all work as a team, treat our colleagues with the respect they deserve and take care of our patients.

I hope you find this to be helpful as you begin your lifelong journey as a nurse! Remember to always be open to learning new methods, interventions, and ways of doing things. To become stagnant and unwilling to learn is to become dangerous. Always seek help when you are unsure.

And remember, those feelings of uncertainty will pass!

If you have any helpful advice, tips/tricks to add, please do so in the comments! We are all in this field together and must build each other up!

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