Starting Work as a New Nurse

Snapshot: This article reviews some of the most common challenges new nurses face, and strategies for overcoming those challenges.

  • iStock_000016737114SmallExpect to feel overwhelmed at first. No matter how well you may have been prepared in your nursing school clinicals, there’s a big difference between being a student and being directly responsible for the care you provide as a nurse. No one knows exactly what to expect when they first walk onto the floor. In fact, it may take you several years before you feel fully competent. Don’t be frightened by this: expect it, and realize that every experienced nurse was in the same boat when they first started out too.
  • Be an observer who’s willing to learn. Especially in the first few months on the job, make an effort to learn how your organization “does things.” Above all, unless you truly believe that patient safety is at stake don’t say, “I was taught differently.” Fairly or not, you’ll come off as presumptuous and rude. Remember, you’re new and will be relying on both the judgment and cooperation of your colleagues to do your job well. Show them the respect they deserve by absorbing the knowledge they have to offer.

  • Ask questions. Asking questions is both an essential part of learning, and a way to signal that you are interested in what your colleagues know. Even the most astute observers usually can’t determine exactly how – or why – their colleagues do things as they do without engaging them in conversation. If you’re the type of person who normally holds back, challenge yourself to occasionally ask for clarification or advice from the people whom you most come to trust.
  • Be helpful and proactive. Nursing is a “team sport,” not a profession for those who “sit on the sidelines.” Don’t wait for your colleagues to ask for your help; actively offer your assistance and pitch in. Not only is this the right thing to do, you’ll certainly need help from others to do your job well too.
  • Be flexible about your schedule and work hours. Especially when you first begin working, understand that fairly or unfairly you are working to gain the approval, trust and support of your colleagues. One of the quickest ways to erode that support is to demand that others accommodate your personal schedule. Whatever inconveniences you may suffer, it’s probably not worth the hassle of gaining a reputation as selfish when you’re first starting out.
  • Don’t gossip or discuss your personal life at work. This should be a no-brainer for everyone (not just nurses) but it’s easy to slip up and cross this boundary. Your colleagues don’t need to know about your significant other’s job or friends, your bar trips last weekend, let alone your religious or political views. It’s easier than you think to irritate or offend others when you mention these topics, and they have no relevance to your job as a nurse. Do yourself and others a favor, and leave it at home where it belongs.

  • Find a mentor. While you’ll probably be assigned a mentor or supervisor during your orientation period, it’s useful to find a more senior nurse – preferably someone who isn’t already your manager – to help guide you and answer questions as you’re starting out. You’ll inevitably face challenges and frustrations in your new job, and a mentor can offer you insight and perspective. If you’re not sure whom to approach, try finding out from your organization’s human resources department if any formal mentoring programs are available, or ask colleagues you trust to recommend someone.
  • Stay organized – and keep up with charting. One of the biggest challenges you’ll likely face in your new job is simply keeping on top of the many things you’re expected to do. As you gain experience, actively question whether you’re planning and delivering your care as efficiently as possible. Whatever you do, avoid the common mistake of leaving your charting toward the end of your shift to complete. Instead, chart as you go to ensure it’s accurate and gets done. Remember: your chart is a legal document, and if it wasn’t charted, as far as your employer is concerned, it wasn’t done.
  • Put your patients first. This may seem obvious, but when other nurses, physicians, and managers make demands on your time, you must remember that the safety and wellbeing of your patients is always your first priority. If you’re ever in doubt that a medication you’re ordered to give or a task you’re assigned to do isn’t safe, seek clarification. While it’s sometimes nerve-racking and time-consuming to ask questions, remember that you are ultimately responsible for the care you provide – not anybody else. Trust your instincts if you feel a patient’s safety is at stake.
  • Possess integrity; admit and fix your mistakes. Some new nurses begin their careers determined to “never make a mistake.” But that perfection isn’t possible – you will make mistakes. The important thing is to possess the integrity to admit your mistakes when you make them, fix them, and communicate clearly with others so they’re aware of the situation. Others will likely appreciate your honesty, and if you show that you have learned from whatever error you make, will be impressed with your commitment to providing excellent patient care.

  • Take charge of your learning. While you may be done with nursing school (at least for now) you’re just beginning a process of life-long learning. Every day, you’ll likely encounter clinical questions you don’t know the answer to or would like to learn more about. Get in the habit of proactively researching topics you’re unfamiliar with, and do what you can to implement that learning in practice. Healthcare is complex and always changing, and as a nurse you need to stay on top of new knowledge and information to deliver excellent care.
  • Attitude is everything. No matter how skilled or accomplished you are, a positive attitude is often the difference between being a great nurse who others want to work with – and being a nurse who brings out the worst in patients and colleagues. Nursing is often stressful work, but how you respond to that stress will in large part determine how successful you are.
  • If you feel burned out, reassess – don’t despair. It’s not uncommon to hear nurses say they’re “burned out” – or, unfortunately, to witness care that is less than compassionate and professional. At times, everyone feels burned out. The key is to recognize the signs in yourself, and take action sooner rather than later. Ask yourself: what’s at the root of the problem? Then, take steps to correct it. And remember, one of the great things about nursing is that if your current unit or role ultimately isn’t right, you can probably move to a new environment that’s a better fit for you and those you’ll care for.
  • Take care of yourself. Nursing requires a lot from us – that we be both skilled and compassionate care-givers. It’s important to consistently work hard to ensure the safety and wellbeing of your patients, but you’ll be unable to deliver the level of care that you should if you haven’t taken care of yourself. Learn to manage stress day to day – take breaks, get exercise, and stay healthy. Don’t let stress build up and boil over. The paradox is that in order to help others, you must also learn to help yourself.