Survive First Year

You did it! After years of education and clinical experience, studying and preparing for the NCLEX, and passing it to obtain your nursing license, you’re ready to find a position that will launch your career AND pay you to participate as a full-fledged member of the healthcare team.

Feeling a little (or a lot) nervous and overwhelmed? You’re not alone. Let’s walk through the steps that will result in a successful start as a Professional Licensed Nurse.

Getting hired: Make sure it’s a good fit for you and a potential employer

You might have started filling out applications and scheduling interviews during the last term of nursing school. Maybe you have a firm idea of where to start your career or what area of nursing seems appealing. Ask a nursing administrator if there is a list of graduates and where they first worked. If you can contact someone who chose the same hospital or specialty as you’re considering, you can get some honest information and advice.

Don’t be too quick to accept a position that may not be right for you. Today’s nursing shortage has employers that are eager to hire and may offer enticing perks to get your attention and fill position gaps . Go to hiring events and open houses at several possible organizations to get a good sense of what working at their facility is like. 

Before you jump on board, ask questions about the opportunities to transition from a nursing student to a nurse who will provide safe and effective patient care:

• What resources and support are provided to new nurses?
• How long is orientation?
• What happens after the orientation ends?
• What is the preceptor/mentor experience?
• Is there a Nurse Residency Program? 
• Will continuing education be provided?
• Is it possible to tour a unit or shadow a staff nurse?

Where to start: What’s your passion?

For decades, new nurses were strongly encouraged to work a year on a Medical-Surgical unit to get a broad foundation of experience before moving to other specialties. However, as inpatient care has become more complicated and insurance reimbursement plans have become stringent, Med-Surg has evolved into its own specialty.

There is no One-Size-Fits-All when it comes to choosing your first nursing position. If you know what you like (or don’t like!) as a possible job, start there. Period. Consider what your long-term

career goal is and choose a facility or unit that will support your plan. Are you gaining experience to become a Nurse Midwife? A Nurse Anesthetist? A Nurse Practitioner in Mental Health or Pediatrics? Find a position that will move you toward your goal.

If your personal situation influences your work choice, that matters, too. Ultimately, there is no right or wrong place to begin. Some options include:

• Acute care (hospital)
• Long term
• Home care
• Ambulatory care
• Practice/Office

No matter where you decide to work, try to ensure it’s a good fit for your goals and passions. If you learn that it’s not what you expected, or that you now have a better vision of what you need, tell your nurse manager. They can help you transfer to another unit or find a way to improve your experience. It’s hard to know what’s best when you start out, and many new nurses discover new interests after being hired.

Your Preceptor is the key to early success

A preceptor is an experienced nurse who makes you feel welcome, helps you become familiar with your unit or work setting, learn procedures, and partner with other team members. Your preceptor directly influences how you feel about your new position, your work performance, your job satisfaction, and whether or not you choose to continue in your new work site. The preceptor teaches, provides feedback, and eventually allows you to function with less and less oversight.

The Preceptor-New Nurse relationship is a professional working relationship designed to make you feel comfortable while observing/performing best practices. Your preceptor should be able to:

• Assist with completion of the Orientation Checklist
• Reinforce skills and competencies and build new ones
• Help with organization and time management skills
• Identify areas of success, as well as areas for improvement
• Allow you to ask questions without feeling judged or criticized
• Make you feel seen and heard
• Adjust the orientation to match your needs and learning style

As a new nurse, you have responsibilities, too. You must use good communication skills, including active listening, acknowledging feedback, and accepting constructive comments. Always respond respectfully. Your preceptor has more experience than you and is there to help you.

During your Orientation period, use downtime to read and become familiar with policies; learn the layout of supply room and location of items; practice procedures that are used on your unit, such as interpreting ECG strips; or preparing for your end-of-shift report. Offer to help other nurses.

If you find that you and your preceptor aren’t getting along or have serious communication issues, speak with your nurse manager. Never discuss difficulties with other nurses or team members.

First weeks and months on the job

If you ever had a job of any kind, you’re already familiar with the feeling of being flooded with new information, instructions, and requirements. Maybe you wondered how anyone could handle all the complexities of the position. But day by day, you catch on to the job and how to do it. Soon you can perform the same tasks easily—and you find yourself explaining procedures to people hired after you.

Being a new nurse is the same, only on a larger scale. Be patient with yourself during the first few weeks and months. Don’t get discouraged or use negative self-talk about yourself and your progress. Other things to do:

• Ask questions! Don’t be afraid of asking for explanations or clarification. Use open-ended questions to get the information you need to understand or perform a task. If you don’t know, ASK! Do not perform a procedure if you are unsure.
• Speak up about topics you want or need to know more about. Make lists to look up diagnoses, conditions, signs, symptoms, medications, treatments, etc. when you return home.
• Get to know other team members and what they do. Physicians, respiratory therapists, pharmacists, physical and occupational therapists, Nurse Practitioners and Physician Assistants all have unique and valuable roles. They may be happy to share their knowledge and expertise.
• Carry a small notebook to list topics to research on your own or new information in a “Quick Reference Guide” section of the notebook.
• Know and follow your employer’s policy on Social Media. Noncompliance with the policy can result in immediate termination.
• Be sure to observe all HIPAA rules and guidelines when using personal devices or social media platforms. Breaches of patient confidentiality or privacy include:
  • Videos or photos of patients, even if they can’t be identified
  • Videos or photos that show room numbers or patient records
  • Patient descriptions of patients, their diagnoses, and/or treatments
  • Referring to patients in a way that is embarrassing, degrading, or demeaning to the patients
• Remember that every single nurse—no matter how knowledgeable and confident they are—was once a new nurse like you. Here are 27 Tips for New Nurses…From Experienced RNs.

Learn your job description forward and backward

You were provided with a job description of your position when you interviewed, were hired, or during initial general orientation. NOTE: If you do not have a job description, notify your nurse manager or Human Resources! 

A job description is a clear and concise outline of a job's purpose, key tasks, required responsibilities, qualifications, and necessary skills. It defines what is necessary to be hired for a position; provides a benchmark for future training and development; forms the foundation of your contract with your employer; and sets definite expectations for both you and your employer.

Minimum components of a job description include:

• Job title
• Summary of the position
• List of duties
• Desired education and professional experience
• Desired qualifications or certifications
• Essential skills required to perform the job
• Who the position reports to
• Employment conditions
• Other expectations, such as adherence to HIPAA, attendance, safety, etc.

A job description can be used to:

• Determine if you are meeting the position requirements
• Evaluate your performance for an annual review
• Assess your qualification for a raise or bonus
• See if you are ready for a promotion
• Allow you to perform a self-assessment

Keep a copy of your job description handy and refer to it regularly to see if you are meeting the requirements. You can also use it to determine if you’re qualified to perform new or unfamiliar tasks. It’s also handy to copy some of the terms in the description when updating your resume or Nursing Portfolio. Keep a copy of every job description in your portfolio as you change positions or roles.

A few more tips and ideas for a new nurse

There is so much to do when you start your new job experience! A few more things to consider as you settle into your professional life:

• Obtain Professional Liability Insurance: Don’t delay getting insurance that will protect you when (not if) you make a mistake.
• Adjusting to night shifts: Day shifts can be based on seniority, so many new nurses start on afternoon or night shifts. Learn how to make the best of the situation.
• Learn to navigate a 12-hour shift: 
• Healthy snacks for the busy nurse: Don’t give in to fast food or vending machine snacks.
• Avoiding Nurse Burnout:  Burnout is a serious threat for all nurses. Learn how to recognize it and what to do if you suspect it happens.
• Join the American Nurse Association to receive updates, information, CEUs, the monthly ANA journal, as well as where local chapters and events are located.

Your first year will pass…quickly!

Starting your first job may seem like there is too much to learn. You may feel like you’re not really ready to independently provide safe patient care. Take a deep breath and look around: Every single team member was once in your shoes…they were beginners, too. 

Ask questions, seek learning opportunities, don’t be afraid to repeat tasks or procedures, study on your own. Check your progress against your job description often—you will definitely see that you’re doing well. At the end of your first year, you will look back and see how far you have truly come!