Your First Year As a Nurse

By Donna Cardillo, RN, MA, CSP, FAAN

Your journey through nursing school has been long and arduous but an end is finally in sight. As you approach graduation you experience a strange mix of relief and panic. The realities that lie ahead as a professional nurse start to creep in making it hard to breath. You question yourself asking, Did I make the right decision to become a nurse? Do I have what it takes to succeed? These feelings are normal and are experienced by all newly licensed nurses. Here are seven strategies that will help you survive, and even thrive, during your first year as a nurse and beyond.

Have realistic expectations
Rome wasn’t built in a day and neither will your nursing career. Experienced nurses know that it takes an entire year to start to feel comfortable in the clinical setting and a full two years to start to develop some level of competency. You still have a lot to learn and are not expected to know everything. Consider your first job as a nurse to be phase II of your education. Phase I was in the classroom. Phase II will be in your new work place.

Set small goals for yourself each week such as learning everyone’s name, mastering the phone system, doing a certain procedure at least once. Track your progress by keeping a journal and listing new skills and experiences. Be sure to write about how you’re feeling too, especially what you’re afraid of. When you go back to read the journal after several months, you’ll see that you’ve come a long way and have moved beyond many of the fears that you initially had.

Immerse yourself in the community of nursing
No one succeeds alone and that certainly is true of nurses, especially new nurses. That means you have to develop alliances, support systems, and lifelines. You need to get and stay connected to the bigger “family” of nurses. In other words, you have to immerse yourself in the community of nursing. How can you do that? By joining and getting active in your state nurses association and specialty association. Just joining these associations will automatically get you tapped into valuable resources, information, and support systems. Get active by attending local meetings and getting on a committee that interests you to get the most benefit.

Align yourself with friendly, competent nurses. Look for role models and mentors. These can be nurses in your current place of employment or those you know through other channels. You can even find these nurses on the Internet via online discussion groups known as listservs and bulletin boards on various nursing sites. Support is every where if you look for it.

Be proactive with your training and orientation.
The nurse educator, your preceptor, and your manager will likely have an agenda for you to move through during your orientation program. However, you should play an active, rather than passive, role in the process. If you know of a certain procedure being done that you need or want experience with, ask to observe and assist. Better yet, ask to perform the procedure with an experienced nurse. If there is something that is not often done on your unit but you need experience with such as tracheostomy care or suctioning, ask if you can visit another unit to get that experience. If you see or hear of an interesting patient, ask to be assigned to him or her.

Be a magnet for help and support
Be someone others want to be around. Introduce yourself to co-workers, physicians, and other employees. Go out of your way to meet those on the shift before and after yours. Address people by name, greet them when you arrive, and say “goodbye” at the end of the shift. Don’t wait for people to introduce themselves to you.

Treat everyone with respect and courtesy regardless of their title or position. Experienced people in positions of less authority likely know more than you do at this stage of the game and can be a great help to you. Remember that you are part of a team and everyone plays a vital role. Don’t forget to acknowledge help and support when you get it from anyone and say “thank you.”

Offer to help others whenever you can. You don’t have to be clinically competent to assist with a procedure, help in turning or transporting a patient, or running to grab some supplies or make a phone call. If you take the initiative to help other people, others will reciprocate without your even asking.

Be sociable

Take part in social functions at work. If everyone is going for pizza after work, join them when you can. If the crew brings in food on your shift, be sure to bring something in occasionally whether you partake or not. If the department is throwing a shower for a co-worker, make an effort to contribute in some way. Attend awards ceremonies, company picnics, and holiday parties. This participation shows you are a team player and support your co-workers. It also shows that you are making an effort to get to know people, become integrated into the group and are working to build relationships. Although you don’t have to like everyone you work with, you do have to get along with them. Deliberate efforts to build relationships will make for a better situation for yourself and reap benefits you never imagined. It will also make you feel more a part of the group and gain acceptance.

Ask lots of questions

We’ve already established that you’ll still have a lot to learn when you get out of school. You know the basics but you’re still going to need to ask plenty of questions along the way. Of course if you need to know something, you should utilize appropriate resources first such as policy and procedure manuals, drug reference guides, and the Internet if there is time. However, some things aren’t written and can only be learned from experienced people. Ask questions when you don’t know what to do, don’t understand something, or need to know why something is done in a certain way. Don’t be a pest, but ask those questions when you need to. Newly licensed nurses who don’t ask questions are more likely to make mistakes and will prolong the learning process.

Unless it is something you need to now immediately, or is minor in nature, it is often preferable not to ask questions in front of patients and preferably not during tense or critical moments. If you have not done a particular procedure, say so beforehand. You might phrase it this way: “I haven’t done this before. You’ll have to walk me through it.” I was once left alone with a thoracic surgeon on the night shift in the emergency room. He needed to perform a thoracotomy on a critically ill patient and asked me to set up a complicated suction/drainage system. I was a novice nurse and had never even observed this procedure. I had to tell him that up front. Although he was at first a little taken aback, he regained his composure and walked me through the whole procedure telling me exactly what he wanted me do. People appreciate knowing that up front. Was I sacred to admit I didn’t know what to do? I was terrified. But a life was at stake and I had no choice. At least I now knew what to do next time the situation arose. It’s all part of the learning process.

Work on staying positive and motivated

It is challenging for all of us to stay upbeat on a regular basis but it is especially challenging when you are getting started in your new career. You’ll often feel overwhelmed and likely question your own ability and purpose. It is therefore necessary to work at getting, and staying, positive and motivated. You can do this in several ways.

Take some time each day to focus on the positive. What did you learn, how did you help someone, what challenging situation did you get through? Reserve a section of your journal to record positive things people say to you, both staff and patients. Accumulate positive sayings and poems and paste them in. Review this section often, especially when you are feeling down.

Associate with positive, motivated, upbeat people. Avoid those that are negative and unhappy. Seek out those who love what they do and are supportive and positive. You can find these people through professional associations, at work, and in your circle of friends and family.

Use motivational materials such as CDs and books. Several books have been published (see below) that are a collection of positive stories and anecdotes about nurses and caregivers. These help to keep you focused on the bigger picture and remind you of why you became a nurse in the first place.

Remember: You’ve got a lot to learn but you’re better prepared than you realize. Be realistic with your expectations, get into an active learning cycle, develop good relationships and alliances, focus on the positive, and keep moving forward. Build a strong foundation during your first year as a nurse, and your future career will be solid.

For additional tips, advice, stories and anecdotes from new graduates read Donna’s book Your First Year as Nurse — Making the Transition from Total Novice to Successful Professional 2nd ed.

©Copyright Donna Cardillo. All rights reserved.