I recently attended my 45th college reunion. I saw many dear friends with whom I've stayed in touch, and others whose faces looked only vaguely familiar until they told me their names. Then I could easily see the 18-year-old women I'd first met when we all began our journey to become nurses.
During those college years we witnessed much political and social upheaval, including the Vietnam War; the assassination of Martin Luther King Jr.; Woodstock; and the birth of the women's liberation movement. Dr. Christiaan Barnard performed the first human heart transplant; the floppy disk drive was invented at IBM. Nurses wore white uniforms (although caps were on the way out); only OR and recovery room nurses wore scrubs. Charts were kept on paper, and we manually counted the drip rate of ivs. Illnesses like HIV–AIDS, methicillin-resistant Staphylococcus aureus (MRSA) infection, and severe acute respiratory syndrome (SARS) had yet to be concerns. Most of us sought jobs in acute care settings and hospitals welcomed us, even in critical care.
This month, many settings will receive an influx of newly graduated nurses. Acute care still remains the main practice setting for nurses—56%, according to a 2013 survey conducted by the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers—and as Diane Mancino, the executive director of the National Student Nurses’ Association (NSNA), told me, “It's still the most desired first job for a new graduate nurse.” In recent years, new graduates have been hard-pressed to find hospital jobs. Fewer positions opened up because many nurses have delayed retirement, worried about the slow economy. Hospitals that were hiring sought experienced nurses. But things may be improving. NSNA surveys indicate that, since 2012, there has been steady growth in the number of new graduates who are finding jobs earlier. Mancino said that this year, many are securing jobs even before they graduate.
Today's new graduates practice in a technologically complex and highly cost-conscious climate. The need to ensure evidence-based practice, accurate data collection, cost-effective high-quality outcomes, and patient satisfaction in the face of rapid patient turnover places significant stress on nurses. High-quality care and patient safety often seem to be more conceptual than operational goals, given the increasing emphasis on patient “throughput”—a manufacturing term for the amount of material that can be processed within a given time. (Is that term one we really want associated with our patients and our profession?)
Thinking about these challenges, I asked several editorial board members and contributing editors this question: “Knowing what you know now, what advice would you give yourself as a new graduate?” Here are some of their replies:
- Gain experience working in different settings and attending different schools. You gather different perspectives, see how things can be done in more than one way, and create relationships that can be called upon throughout your entire career.
- Prepare for stress. Stress will be all around you, no matter which bedside you begin your career from.
- Find a nurse or two whose practice you really admire, and learn from them. Ask questions… give yourself time to learn.
- I regret thinking small and not envisioning, with the help of mentors, the depth and breadth of opportunities available in the nursing profession.
- I'd be more proactive in seeking educational advancement.
We asked Amanda Anderson, a recent graduate intern at AJN and now an editorial board member, to develop a column for new nurses. Transition to Practice debuts in this issue and will appear quarterly. Anderson is grounded in clinical nursing and has good insights we think will help nurses as they begin their professional careers.
My advice to new nurses: show up early, show up ready, and listen. If you don't know something, ask. Read journals (and not just specialty journals—you need a broad view of health care and nursing). Attend a national conference at least every other year. Get comfortable introducing yourself to colleagues. And for those of you who'll be acting as preceptors for these new colleagues, should you occasionally feel a bit frustrated with their fledgling abilities: remember, we were all new nurses once.