Secondary Logo

Journal Logo

Department: Education Extra

Practical advice for new graduate nurses

Cockerell, Kimber MSN, RN, CNE-cl, CPN; Stamps, Adrian MSN, RN

Author Information
doi: 10.1097/01.NME.0000723404.53563.d5
  • Free
Figure
Figure

Fear isn't uncommon when leaving the nursing student role and entering the stressful and demanding world of bedside nursing. This apprehension is contributing to new nurses leaving the profession within 1 to 2 years of practice. Starting your first job after nursing school can certainly bring on an uncomfortable feeling as you take on the responsibility of caring for patients. During the early months as a graduate nurse, it's normal to experience the shock of the transition, including a lack of confidence in your knowledge and skills and the fear of making a mistake. You may also be worried about passing the licensure exam and navigating a new workplace, on top of the newfound accountability for patient care. This time can be scary, but it doesn't have to be.

In this article, we offer practical advice on transitioning out of school and into your first nursing role so you can form a foundation to thrive as a new nurse.

You didn't learn it all

Overall, nursing school should help you feel confident in your knowledge and skills. Nursing school prepares a generalist nurse by teaching foundational nursing concepts that can be applied to all kinds of patient populations. This information is applicable wherever you work, but you must also be prepared for new information. You may have noticed that in school you didn't have a heavy focus on specialty courses. You may have spent little time in the clinical setting for certain areas of practice. If you choose to work in these areas, expect to have some extra homework to do. You'll also need to become familiar with workplace-specific protocols and procedures. You'll come across uncommon disease processes, medications, and treatments.

Although you've graduated from nursing school, the learning has only just begun. And not just because you're new. Even experienced nurses must constantly learn because information in healthcare is growing rapidly and what was taught in nursing school is continuously updating to reflect the current state of practice. Coming to terms with the fact that you didn't learn it all (and that's okay) is an important step toward accepting your new responsibility as a graduate nurse and a lifelong learner.

Seek the answers

It's completely normal to feel overwhelmed by the new responsibility of your nursing practice. As mentioned previously, nursing school has given you a strong foundation to start in your new role. When you come across situations that spark questions, seek the answers. There are many resources available: You can search reputable websites, refer to hospital policies, or look at recently published clinical practice guidelines. Don't forget that your coworkers are another excellent resource. Your colleagues have unique experience and can be your go-to for certain skills or issues.

For example, maybe you've never administered a certain drug. You may first choose to review the medication information in a drug guide resource, then ask a colleague about his or her experience or knowledge administering the medication. In this example, an interprofessional colleague such as a pharmacist may be able to provide needed insight as well. Asking questions represents your desire to learn and provide the best patient care and doesn't reflect poorly on you. In fact, unsafe nurses are those who don't ask questions.

You may find yourself asking questions such as:

  • I haven't administered this medication before. What would you watch out for?
  • I haven't performed this skill before. Can you come with me and ensure that I do it correctly?
  • I haven't handled this situation before. How would you approach it?
  • Where can I find the policy or procedure for this?
  • How would you document this?

These questions may seem simple enough, but sometimes you might just need a little reassurance along the way. And remember that based on your education and experience in the clinical setting, you have something to offer your colleagues, too.

Develop relationships

Developing relationships can help ease the anxiety related to starting your nursing career. We can't emphasize this enough. Nursing is a team sport. No one can do it alone. Making a deliberate effort to cultivate working relationships and even friendships can make you feel more comfortable during this transition. Although it can be a little intimidating to make a connection with nurses who have more experience, there are so many benefits to building rapport with your seasoned nurse colleagues, such as opportunities for communication, growth, and education.

Important relationships to consider are those with members of the leadership team, nurse managers, charge nurses, unit educators, and nurse residency coordinators. They can form your support group, serve as an avenue to ask questions, and even lend a helping hand. If you're available and willing to help others, they're more likely to do the same for you.

Relationships with your peers are also important. It's refreshing to talk with new nurses who are in the same position as you, some with the same struggles and others with different struggles. Reach out to your graduating class, new nurses on your unit, and nurses working on other units who you met during your residency program or orientation. These peer relationships can help guide your transition to practice; provide reassurance; and aid you in developing a range of communication, leadership, and critical-thinking skills.

Mentorship can be both formal and informal and is vital in the transition to nursing practice. Several organizations offer formal nurse mentorship programs and pair newly hired nurses with a seasoned nurse mentor. It can also be helpful to seek your own mentor (see Locating a mentor). An informal mentor can be a nurse who has helped you on your unit, one of your previous nursing instructors, or your nurse preceptor. Seeking a good mentor not only helps you gain confidence through building on knowledge and skills, but also creates a safe place to ask questions and learn from mistakes.

In nursing school, you learned about the importance of effective communication and teamwork and how they lead to safer, higher-quality care. Think about the benefits of having a strong team of nurses working with you during your shift. If you can effectively communicate your needs, help other nurses, and feel confident asking questions, you'll be able to provide more efficient and timely care.

Strive for excellence, not perfection

As a nurse, you have a fundamental ethical principle to do no harm. When you have safety and patient care in mind, this creates a nagging feeling of having to have perfect standards. Striving for perfection is what makes you a great nurse, right? Well, not necessarily. Perfectionism can create unattainable expectations and stress related to perceived failures. Rather than setting yourself up for burnout and self-retribution, strive for excellence, not perfection. Nursing excellence is achieved when you give your all in every patient encounter and deliver high-quality care for each of your patients. To achieve this aim, focus on quality, safety, communication, collaboration, using evidence-based practice, and improving patient outcomes.

What about mistakes? Are you a failure if you make a mistake at the bedside? No! Remember, you're aiming for excellence and not perfection. It's important to understand the appropriate steps to be taken if you make a mistake so errors are properly reported. However, you can learn valuable lessons from mistakes. Earlier we talked about not knowing everything when you first start out, and that's okay. Transformational leaders create a just culture, meaning you'll be held accountable for your actions, but are empowered to strive for excellence, use creativity, seek opportunities for growth, and problem solve. Inevitably, this process may involve error, and this is where growth and learning will occur.

Combatting the fear

You've been given the tools necessary to be an excellent nurse. Now, it's up to you to use them. You're in control of your practice. Remember, you'll come across unfamiliar aspects of delivering patient care. Don't let this discourage you. Ask questions, develop relationships to build a community of support at work, and seek to do your very best. Keeping these things in mind should help lift some weight off your shoulders and help lessen the fear and anxiety that the transition period can cause. You'll be a great nurse!

Locating a mentor

Websites

American Nurses Association:www.nursingworld.org/ana

Johnson & Johnson:https://nursing.jnj.com

Sigma:www.sigmanursing.org

Forums

Allnurses:https://allnurses.com

Other

Local hospitals; specialty organizations; and other local, state, and national organizations

REFERENCES

Tyndall DE, Scott ES, Jones LR, Cook KJ. Changing new graduate nurse profiles and retention recommendations for nurse leaders. J Nurs Adm. 2019;49(2):93–98.
Warner SL. Productive errors: transforming learning experiences in healthcare. Nurs Manage. 2016;47(9):36–39.
    Wolters Kluwer Health, Inc. All rights reserved.