New Grad, First Job, Big Feelings: Advice From Someone Who’s Been There
Hi there, I’m Ellen Heredia- a grad school adjunct professor at a major university, a practicing Acute Care Nurse Practitioner, and the Clinical Lead of Operations for my department… but once upon a time, I was you!
You’ve just completed years of work in nursing school, clinicals and cramming for the NCLEX (CONGRATS on passing!) and now you’re here. You interviewed, picked your speciality and signed on for your first job. All of the excitement from finally getting here competes with the feeling of overwhelm as you walk into that first shift as “the new grad”.
I’ve been there and you’ve got this.
This post is for all of you who are staring down your first real shift: Practical advice for how to thrive in your new nursing gig.
Imposter Syndrome: It’s normal so don’t let it derail you
Listen, we have all felt it. When you walked into clinicals for the past few years you were the annoying tag-a-long, and now you’re one of them. You’ve read it all, listened to all the content in lectures, and passed the tests- but now you’re looking at a real human and you have to apply all that book knowledge to a real life situation.
And you’re it!
Reframe this phase as a recon stage: observe, gather data, and ASK THE QUESTION. You’re new, you’re supposed to have questions, so ask them! There’s nothing more terrifying than a new grad who pretends to know it all.
Pro tip: grab a little notebook (or, as I affectionately call it, your diary) and make notes, tabs, etc. I gift one to every person I’ve ever precepted and encourage them to write everything down. It takes a while to remember who to call for what and the code for the clean holding. Write it down or put it in a notes app.
That med with the weird rules about reconstituting…. write it down so next time you’re hanging it you don’t have to phone a friend. The environmental services guy who does the best job with stocking and cleaning…write down his number.
Before you know it, you’ll be passing that information down to the next new grad.
Crack the Code on How your Unit Actually Works
You’ve learned how nursing units and hospitals ideally function. You know the standards, the expectations, and how to deliver safe care. But now you get to learn the real real: the systems, players, the politics and how to navigate it all.
- Figure out the chain of command- Know who to call and who is in charge. You WILL need help; knowing who to ask FIRST is crucial not only for your survival but for your patients, too. Take an interest in building rapport with the nurses and physicians who are in leadership roles in your unit. They got to those roles for a reason, and you can learn so much from watching how they work.
- Find your people. Hopefully, this starts with your preceptor, but also pay attention to who is competent, efficient and inclusive. Pursue friendships with them or even informal mentorship. If you have opportunities to meet outside of work with your team, do it! It will help you build relationships, foster community and will help you understand your unit even more.
- Pro tip: once you’ve got your sea legs, pick up a shift on the opposite schedule. Meeting people on nightshift when you typically work days is invaluable. Nursing is a 24/7 job, so having some besties on the opposite shift can make or break your days.
- Take Advantage of Resources. This is a little tough love, but tackle orientation like school and boards prep. You thought you were done with all that, but not quite! Sign up for available trainings, EMR webinars, and unit or hospital based certifications. Attend the meetings and take notes. This is where you will find out how to work smarter, chart faster, and leverage your options. The more efficient you are and the more resources you use to support your work, the more you will protect your own mental health and free up brain space to show up for your patients.
Timelines & What to Expect
Honing your skills and competencies as an RN takes time! No one becomes an expert overnight and it's important to extend grace to yourself while you develop as a nurse.
First Month
Learn the basics. Pay attention, observe, absorb and above all else, focus on safety. Go slow, speak up when you’re not sure about something and ask questions.
Write things down so that as you learn something new you can try to transition to independence (aka not asking the same Q over and over).
Months 2-3+
Start anticipating needs, tasks and routines. Get organized. Master the big picture and what you need to accomplish within the next 12 hours.
Take baby steps on completing basic tasks independently and accurately.
Celebrate all the firsts along the way– your first IV, foley, bedside procedure… These are all rites of passage, and you deserve a pat on the back!
6 months+
You’re competent. You’re in the driver’s seat of your patient assignment for the day. You rely on your preceptor, mentor or charge nurse for help with more challenging tasks or therapies that you don’t see often, but you’re independent in your daily practice and becoming more efficient.
You’re starting to take more complicated patients and you’re learning more advanced skills. Your hard work is paying off- you’re confident in your bedside skills, you’ve developed strong relationships with your colleagues and now you’re even able to start pitching in to help your bestie when they need a hand.
Year 1 and Beyond
Now you’re a resource. You may be training to be in charge, or you may even be precepting your own new grad. You’re confident in your abilities, and you’re a rockstar nurse.
If your first job wasn’t your dream job, you may be interviewing for a new unit or a different setting. Whatever it is, you’re competent and prepared to go out into the world and crush it.
For a lot of us, nursing is more than a profession- this job is hard but it is also incredibly meaningful work. We have the honor of being with humans during incredibly vulnerable times in their lives.. You have an opportunity to offer compassion, preserve dignity, and be with people during grief, celebration and recovery.
What a gift.
Welcome to the club!
Adjunct Professor and Lead Nurse Practitioner