My apologizes for no post yesterday – I was working! Today I’d like to talk about that magical moment in nursing when everything just clicks.
The first year in nursing is an incredibly difficult and challenging experience. I personally think it’s one of the hardest transitions from school to work, but that’s based on my experience as a nurse without any experience in other fields. However, the learning curve in your first year of nursing is intense. My nursing program was only twelve months long (second degree BSN), so although I got in the required number of clinical hours, it still didn’t feel like much. Upon graduating, I knew the only thing I needed to do was to actually work as a nurse in order to really put it all together, but that’s kind of a scary thing!
I always say that I could have passed the NCLEX, the boards for nursing, without actually having gone to nursing school. Someone is probably going to get mad at me for that, but I finished in 95 questions (you can do either 95 or go on to something like 250-ish) and it was all over in under an hour. I remember it seeming so easy, although maybe I just had an excellent education and that’s why. Passing your boards doesn’t necessarily mean you’re going to be an amazing nurse. Taking what you actually did learn in nursing school (even if it seems like you didn’t need it for the exam!) and applying it to real life is mind-blowing.
In nursing school, they teach you what you NEED to know. To be safe. To kind of learn to think like a nurse. They don’t necessarily teach you how to be a nurse. Many nursing students are able to do internships where they spend a summer working on a unit, or their last class in nursing school is basically a semester long preceptorship. In my accelerated program, we did this for three weeks. So my feet were a little wet, but it was more like dipping a toe in the water. I don’t regret my accelerated program, but I do think people who went to four year programs are a bit more used to the hospital and excel a little quicker in their first year. (I can’t speak to associates programs because my hospital doesn’t hire ASN nurses anymore.)
If you started reading my blog way back in 2009, you may remember that I cried all the time. I graduated in December 2008, which was the month the market crashed. I couldn’t get a job, so after applying to over 250 jobs, I had to take the first one that came along. It was the opposite of everything I wanted, but I had to take it. I cried when I accepted it. And then I cried for about a year straight. It was challenging to learn to be a real nurse, and I didn’t have support from my manager – she used to call me at home to try to explain why something went wrong.
On my third day off orientation, a patient who was being discharged within the hour asked for IV pain medication. Although new, I realized that if you’re requiring IV pain medication, then it’s not really appropriate for you to be going home, as your pain should be controlled on oral pain medication. I told this to the patient, who got very upset. My manager called me into her office a few days later and said I really upset a patient, although to this day I still don’t think I was wrong. Needless to say, I had a very challenging first year in nursing. Not only was I trying to figure out how to be a nurse, but we were always short staffed, we floated three times per week, and everyone was scared to get yelled at by our manager. Luckily, the nurses were very supportive of each other, so that was helpful.
Aside from the toxic work environment, learning to be a nurse is just HARD. You don’t know what’s normal until you’ve seen both normal and abnormal. When a patient would ask me about something and if that was usual or not, I’d usually say, “Ummmm I’ll be right back,” then scurry out to find a more experienced nurse to ask. (Remember, it’s always better to ask than it is to make a mistake!) Learning to prioritize your tasks is a skill you can only learn with time. On nursing school tests, the joke always was, “It’s not what the right answer is, but what the MOST right answer is.” On the unit, there are many important tasks to be done right now, but what is the MOST important to do right now? Learning that can be so challenging. I like to tell nurses that I’m precepting that no one will get hurt if they don’t get their Vitamin C or Colace (a stool softener) on time, but make sure you give the antibiotics on time! Learning this definitely changes your outlook a bit, and it helps you to think about what you need to do NOW and what can wait a bit. That’s a hard lesson to learn.
People always say that after a year in nursing, something will finally “click” and you’ll “get it.” When you’re in the depths of wondering if you’re meant to be a nurse and crying in the medication room (That was me…often), you definitely don’t think it’ll ever be easier. But it was true – after about a year, I got it. The nurses around me were right, and I so appreciated their support along the way. The times when they took care of my patients when I was overwhelmed. The times they told me sometimes it just sucks. But like them, I finally got it. I started eating dinner at work. (Nursing diet = not eating dinner for a year straight!) I felt more confident talking to my patients and didn’t feel like an imposter walking into a patient’s room, writing my name on the white board, and saying, “Hi! I’m Susan, and I’ll be your nurse today.”
Last year, I had my first full time preceptee – she was with me for her entire orientation except for a couple shifts. It’s an eye opening experience to see nursing through the eyes of something else. It’s also an amazing reminder of what it’s like to be new. It helped me see just how far I’ve come and how many things were learned along the way. I would explain an idea/procedure/policy that totally made sense to me, but I realized that was something I learned over time. We had our challenges along the way, but the most important thing is that this nurse really cared – she wanted to learn, she asked questions, she didn’t want to make a mistake, and she really cared about the patients. Some people get it right away, some people take a little longer, but if you care and ask questions, you’ll get there eventually.
In nursing, it’s great to help out your other nurses. This often means going into the room of a patient who isn’t yours and seeing what they need when their call light is going off. That can be a scary thing for a new nurse – you don’t know what you’re walking into. Will they need a water refill? Pain medication? Are they bleeding? Vomiting? Who knows. As a more experienced nurse, I can walk in to a room and at least figure out what I need to do next, even if that means finding the patient’s nurse because I don’t know what the answer is. A few weeks ago, the nurse I precepted was talking to me about this. She said how she was amazed at just walking into someone’s room and knowing how to help them, but now she feels confident that she can do that for others. That’s a HUGE step in nursing – it’s been a little over a year since she came off orientation, so that’s right on target.
It’s a great feeling to know that it’s clicked. You’re always learning and never stop asking questions – nurses who have been working for over twenty years still ask questions. I ask questions. There’s a lot to know and remember, and it’s always good to get a second opinion if you need one. It’s also great to be able to give that second opinion.
Nurses in their first year have a high turnover rate, with many of them leaving the field of nursing altogether. I know I thought about it, but I listened to other nurses I knew who told me to give another job a chance – at least working in in a non-toxic environment would let me see if I really liked nursing or not, and I’m glad I did. It’s hard to be a nurse, and it’s even harder to learn to be a nurse. But it’s so, so awesome when you finally realize that you kinda-sorta-maybe actually know what you’re doing, and you write your name on that white board with full confidence.
If you’re thinking about becoming a nurse or you’re in nursing school (or even starting that first job!), just know that it does get easier and you will get there. Lean on the nurses around you – we really want to help the patients and to help you succeed. It’s definitely worth it in the end.
Nurses – Any first year nursing stories or advice to share? What was your experience?
Non-nurses – What’s it like to be new in your field?