December will mark my four-year anniversary as a registered nurse. I have no idea how that happened. In some ways I feel like quite a seasoned nurse overall – I’ve seen my share of practice settings, I’ve honed a lot of skills and I’m finding leadership opportunities at my workplace.
On the other hand, there are nights when I feel as if I just stepped out of my pinning ceremony. In so many ways, I feel like I’m still finding my feet. My only consolation is that nurses who have been doing this for years, even decades, are sometimes still finding their feet too. I’m discovering that I don’t have to know it all – I just need to know where to look and who to ask. It’s comforting (and exciting) to know that I’ll still be learning 40 years from now.
Since I’ll be precepting a new grad nurse this fall, I’ve given a lot of thought to the transition process from student to professional RN. Especially considering how rough my own transition turned out to be…
I’m more determined than ever to give her a positive experience, to help her realize what a privilege this job truly is, to learn and grow and be confident that she will survive, even on the nights that make us all question ourselves. I want her to understand that transition shock is normal, that she will get through it, that she will hate nursing even when she loves it and she will love nursing even when she hates it.
In the past year I’ve seen two extremes from new grads:
1) The Doubters – These nurses don’t believe in themselves yet and therefore ask a million questions. They may struggle mightily once they’re “on their own” and even drown for a bit. Everything is overwhelming and nothing is clear. Since those first months of nursing are so task-oriented, they haven’t developed the critical thinking skills to process problems on their feet. They are constantly asking for help and rarely believe that they can do anything right. They also tend to be very “by the book” because it’s more comfortable there.
2) The Know-It-Alls. These folks act as if they’ve got it figured out. They ask barely any questions, complain about other nurses/doctors/staff members as if they’re the only ones who have their sh*t together, and sometimes even treat you like you’re a blithering idiot. At times they can be downright condescending. Sometimes their confidence comes from being better at technology (such as electronic medical records), and using their knowledge to lord it over the more experienced nurses.
Obviously most of us fell somewhere between these two ends of the spectrum. Very few of us fit either stereotype. In my PCU job, I was a doubter through-and-through. In this job, I’ve tried to find a balance between hounding the experienced nurses with questions and relying on my own knowledge. There is some truth to the “fake it ’til you make it” mantra. On the other hand, faking it can kill your patients. So a dose of humility is never uncalled for.
If I had my druthers, I’d rather work with a Doubter. Confidence can be built over time with positive reinforcement. Questions can be reflected back with more questions, forcing a new nurse to think through a problem, rather than always relying on the judgment of others. Students don’t pass the NCLEX and suddenly become sages. It takes time to develop into a professional nurse. Time and mentorship and support. I’d rather be bombarded with questions than find out later that a new grad brushed off a warning sign because they thought it was no big deal. That to me is a much bigger danger sign than someone who is drowning a month off of orientation. Hell, I’m still drowning on some nights. It’s the nature of the job.
In some ways, I feel like I got to be a new grad twice. The first time I struggled with the cognitive dissonance of my job, felt unsupported by my leadership and ultimately succumbed to health problems that did me in mentally and physically. The second time I got to emerge from the ashes of my previous acute care life, armed with knowledge, education, increased confidence and two additional years of developing my assessment skills in the community (not to mention learning survival and resilience). Not only was I better prepared and better equipped this time around, I was surrounded by a community that wanted me to succeed. I was working in a specialty I loved. I was ready for the challenge.
I got a do-over. May the lessons learned from the past four years make me the kind of preceptor who helps new nurses not need the same.