"It’s Better to Ask a Stupid Question, than do Something Stupid and Have to Explain Yourself."- Teri recalls her first month as a nurse.
The first month of orientation I find it to be crucial to your success as a professional nurse. It's a period of time of intense information overload, learning a new environment and meeting new people, all that on top of the fact that you are now legally responsible for your own nursing decisions. That can add tremendous pressure on any new nurse. A welcoming team can help relieve the stress, and an educational and professional unit culture plays the ultimate role on a nurse's success
I have had the pleasure of working with a new graduate nurse, Teri, who just finished the fist month of orientation, and I was curious to know how she was adapting and what were her thoughts on the orientation process, perhaps even share pointers with others going through it, or are applying to start their new role soon.
Teri Whitehead, RN, ASN also graduated with a minor in psychology, and is going back to school in the fall for her BSN degree. So I sat down with Teri and asked her to share her experience and any survival tips.
-When did you graduate nursing school?
I graduated nursing school December 12, 2017. I remember having that day marked on the calendar and a countdown on my phone. It couldn’t seem to come fast enough.
-What did you do before graduating nursing school and how did that help you become a nurse?
When I was in school, I was terrified of the hospital. With the unfamiliar beeping, patients crying out, intimidating doctors marching past you in their white coats, and your clinical teacher watching you like a hawk; I had overwhelming anxiety every time I stepped foot inside. I thought “If I can’t become confident, how am I supposed to become a good nurse?” I remember talking to one of my friends and she had told me about a “nurse extern job” some hospitals offered, and I got online that night and started looking. Once I was hired and starting working, the fears and anxiety I once had in clinical melted away. Because I wasn’t so scared from my experience and exposure to the floor from the extern job, I could finally start using my clinical time to learn and practice my critical thinking and skills. I went from fearing clinical, to becoming excited to go every week.
-Tell me more about the program, and how else did the nurse extern program assist you, would you recommend it to other nursing students?
I became a nurse extern a year into nursing school, and it was honestly the most helpful thing I could’ve done in my journey to becoming a nurse. For those of you who aren’t familiar with the term, a Nurse Extern is a student who is enrolled in Nursing School and has completed at least two clinical rotations; and acts as a CNA in the hospital with additional duties and responsibilitiesHowever, you are also allowed to perform nursing skills, such as inserting IV’s and inserting foley catheters, as long as a nurse is at your side. At least once a shift, I would have a nurse pull me in a room to watch a procedure I hadn’t seen before. In this time, I got to be in the room for rapid-responses, learned from watching about diagnoses and medications, learned how to interact with hospital staff, and simply gained confidence.
I will never forget a rapid response during my time as an extern, where a patient went into SVT and the nurse pushed adenosine. After the expected pause, the patient converted into sinus rhythm. Several weeks later, I had simulation lab where this exact same situation occurred, and I immediately identified the rhythm and correct treatment from witnessing this situation.
Being a nurse extern also allows you to learn how to react and respond to situations, as well as quickly transition from a nursing student to a nurse. You get to know the managers and staff, and are more likely to be offered a job than an outsider.
Lastly, when it does get to be your first day as a Nurse, it isn’t as scary as it would be going to a brand-new hospital. There are familiar faces who are encouraging and helpful. I’ll never forget my first day when I got to wear my “RN blue” instead of “Tech Tan,” and all of the “Look at you in blue!” comments I received. It felt great. I definitely would recommend it to everybody in nursing school.
-How did you prepare for the NCLEX? When did you take it?
About 6 weeks from graduation, I purchased UWorld and practiced an average of 50 questions a day. I personally loved UWorld because of the challenging questions and rationales that had pictures and great explanations.
When it came time for our HESI review, I felt prepared to attend it from these practice questions. After graduating, I took some time off from studying to see family and go on a trip, but finished the UWorld bank by the time I received my ATT. I scheduled my NCLEX for the first date available and ended up passing in 75 questions!
-How did you prepare for your first day of orientation? (On the unit, not general orientation)
I couldn’t sleep before my first day of orientation because I was so nervous! I brushed up on EKG rhythms and packed a bag full of every nursing supply you can think of.
-Are you part of a new graduate nurse program? What do you perceive to be the benefits and downsides of it?
Yes, I am in a new grad program!
-Pros: I really like the extensive training we are given (8 weeks for Telemetry, 10 for Stepdown, 12 for ICU; more if needed). I also like the daily and weekly meetings we get to make sure we are on target. Working on a critical care floor, we also get to attend a 6-week critical care class, where we meet once a week for 8 hours to learn more in depth about how to effectively be a nurse on the floor. You also become ACLS certified, BLS recertified, go through an extremely informative EKG class, and receive enough education credits in this time to renew your license!
-Cons: As much as I love the new grad program, the biggest downfall is having to sign a contract that binds you to a floor and hospital. Also, the longer training period means more time of training pay instead of the normal RN rate.
- How did you get matched with your preceptor?
A manager on the floor picked my preceptor. I had never met him before, but I got lucky to be paired with such a great nurse. My preceptor is a great teacher who gives great explanations, is patient, and sets an amazing example of how to stay calm in scary situations. I really look up to him as a nurse.
-What has been the greatest doubt you had coming in, that your preceptor helped clear up?
Personally, I was terrified of talking to doctors. From working as an extern, I wasn’t scared of patients or their families, but physician communication was a new area for me. I was scared of being yelled at or not knowing the answer when they asked me a question. The best thing my preceptor has done for me in this regard is learning from watching him interact with the doctors, and having me become exposed to these situations by being the one to have the phone all day to call and talk to the doctors. Yes, I have been yelled at once so far, and it was embarrassing. The doctor’s words rang in my ears for the shift, but as my preceptor reassured me, I am a new nurse and I will get better with this with time and experience.
-What's your greatest fear when you go to work?
My biggest fear when I go to work is causing a patient harm. My second biggest fear is disappointing my preceptor.
-What do you feel comfortable with already? (Skills, knowledge, etc..)
I feel confident with charting. I also feel comfortable with the routine I have established. I feel comfortable with many of the cardiac medications and the care I need to provide with certain cases (for example, I feel proficient in caring for a patient after a cardiac catheterization).
What has really helped me in this time is getting to work about 45 minutes-1 hour early every day and taking the time to look up my patient’s labs, diagnostic tests, and medications. Getting myself prepared before the day starts helps keep me organized, which in turn helps me have a better day. I like to be able to walk into a patient’s room and already know their story.
I still need to work on time management when it comes to medication passes. I also need to work on physician communication, especially over the phone. I get nervous still when I make calls out. I also need to work on my confidence in myself as a nurse.
-What would you like to take away from your orientation period?
It might be unpractical this early on, but I want to be a nurse who is trusted. I want to be the nurse who is watchful and caring, who family members feel safe leaving me to care for their loved one. I want the other nurses on the floor to be able to trust me and my judgment. I never want to be the nurse who you get report from and know a mess is coming.
-How have you stayed motivated?
As cheesy as it is, I’m still excited every morning when I go to work. Sure, I’m exhausted some days, but I think the key is accepting a job on a floor that you are passionate about (for me, that’s critical care and cardiovascular care). I also get to learn something new every day, and I love knowing I am growing every shift.
-How have staff been treating you? (Any conflicts?)
When I transferred to a new floor when I became a nurse, I was nervous that the staff wouldn’t like me, but that couldn’t be farther from the truth. The nurses are quick to help answer any questions I have or lend a helping hand. They also encourage me and give me some great advice.
I had a great experience working with Klaus (Me!). I was walking to give medication to my A bed patient, and saw a commotion happening with his patient in the B bed. The patient was experiencing chest pain, and Klaus had called for stat labs, a stat EKG; while another nurse was calling the doctor. It turns out the patient was having a STEMI, and I was scared. However, Klaus and the other nurse assisting were extremely calm and systematic in their care, and Klaus even took the time to show me how to interpret a 12 lead EKG to see which area of the heart was being affected. I really appreciated the time he took, especially in such a scary moment, to teach. Afterwards he even reached out to me and was extremely supportive. I think it’s really important as a new grad to identify the nurses on the floor who enjoy teaching new grad nurses and want to see you succeed.
While most of my experiences working as a new grad nurse have been great, I know the reality is you are bound to have some bumps in the road with coworkers. I had one experience where I was belittled by another nurse and, as hurtful as it was, it taught me that as a nurse you have to maintain your composure and positive attitude. Even though it was difficult, I went into my next shift and put it behind me. I didn’t let myself cry, as much as I wanted too. I had anxiety going back to work that whole weekend. I worked hard for my license and put 100% into my work every day. Situations like that are inappropriate to happen in a professional work setting, especially where the only people who will suffer are the bullied nurse and patient. However, overall the hospital staff are extremely helpful.
-What do you expect from your clinical manager?
I think a clinical manager should be there to support and encourage new graduate nurses and be there to talk too if any problems should arise.
-What role do you think the manager and ANM play in your orientation and success as a nurse?
For new nurses who haven’t worked at the hospital, your managers are the first faces you will see. I believe that your managers hold a crucial role in your orientation period due to them assigning your preceptor. My managers have helped me by giving advice about being a new nurse, as well as sharing little tips they have.
-What could you tell new nurses coming in that may be helpful to survive the first month, and their orientation.
While it hasn’t happened to me, I think it’s important that you and your preceptor have a good relationship. If you aren’t learning from them or aren’t getting along, it’s your right to talk to your manager and request a different one!
A great piece of advice I have received upon asking a “stupid question” is “It’s better to ask a stupid question, than do something dumb and have to explain yourself.”
Use your orientation time to go and experience procedures you may not later get an opportunity to see! For example, on my floor we receive many post open-heart surgery and valve replacement patients. I asked my manager if I could see a surgery, and she set up a day where I got to see two procedures in the OR, one of them being an open heart. I also got to shadow the Charge Nurse and go to the Cath lab as well. Your manager wants to help you succeed and become a great nurse, and don’t be afraid to ask them if you want to see something!
We became nurses to make a difference, and I’ve realized that sometimes even just a little chat or finding a recliner for their family member to stay the night can do that. It’s a great feeling to leave your shift knowing your patients are happy.
Lastly, we have to take the time to stop and shake off the small stuff. All those times spending hours studying for exams and writing care plans, all the stress and missed plans, all of it, were worth it. You did it, you survived nursing school, you passed your NCLEX, you got a job, and you’re here. Here’s to making it count. 😊
Teri has continued to shine after her first month of orientation, I followed up with her preceptor who had full confidence that she will do great because she asks questions and is not afraid to seek out learning opportunities. The goal of every nursing unit is to see their nurses succeed and pass on their knowledge to newer nurses coming in.
The Dude Nurse
Klaus Campos, BSN-RN