After learning about cultural diversity by reading a nursing textbook, five nursing students from Pennsylvania College of Technology got to go out and experience diversity firsthand. Participating in a study abroad course, students traveled to the small town of Nueva Santa Rosa, Guatemala to treat patients in a medical clinic for seven days.
The Penn College students were led by Christine B. Kavanagh, the instructor of nursing programs, and accompanied by a larger volunteer group from Glens Falls Medical Mission. Glens Falls is based in New York and leads weekly trips to the small Guatemala community twice a year to help patients who live two hours away from the nearest hospital.
During their weeklong stint at the medical clinic, the group of volunteers saw over 1,300 patients by communicating through translators. They practiced in five clinical areas including triage, dental, pediatrics, women’s health, and general medicine, providing basic screenings, treatments, medical education, fluoride for dental care, and referrals to outside specialists when needed. Students were amazed by the positivity exuded by their patients who experience a wide variety of issues, not just medical.
Penn College offers a variety of study abroad courses, but this was the first time nursing students participated in a trip. After a successful mission, they hope to offer the course and service trip to nursing students every fall. In addition to the nursing trip, Penn College also offers a course in providing dental hygiene education in the Dominican Republic.
Depression in nurses is considered a silent epidemic, with nurses experiencing depression at twice the rate of others individuals according to a 2013 initiative from the Robert Wood Johnson Foundation. When University of Kentucky (UK) senior nursing student Sarah Wise started to feel stress, anxiety, and depression due to the pressures of nursing school, she realized she might not be the only student feeling the mental health effects of a rigorous nursing curriculum.
Many students feel a pressure to perform well academically. With expectations to master clinical skills and classroom material simultaneously, nursing students must find a balance between academics, clinical hours, and personal relationships. Coupled with learning how to cope with the pain and suffering that comes with spending time in a medical setting, the stress of nursing school can take a toll on the mental wellbeing of even the most seasoned student.
When Sarah decided to share her mental health struggle with her friends and classmates in the nursing program, she realized she wasn’t alone. With the help of classmates Kayla Combs and Cassie Snodgrass, the three nursing students organized a research project exploring the prevalence of mental health conditions in their fellow undergraduate nursing students. They decided to survey 160 sophomore nursing students at the University of Kentucky based off the fact that clinical rotations begin sophomore year.
According to UKNOW, their study found that 27 percent of sophomore students were taking medications for mental health disorders, 30 percent were dealing with mental health conditions, and most students rated their stress level as an eight or nine out of ten. In addition, they found that few students were utilizing on-campus mental health resources.
These results led to the creation of SMASH – Student Mentors Advocating for Student Health. SMASH uses peer advisers to teach coping methods and stress management skills, letting students know that they have a support system for dealing with mental health issues. The students who created SMASH hope to make a difference in fighting mental health stigma and inspire other college campuses to implement similar programs.
“Success is not final, failure is not fatal: it is the courage to continue that counts.” —Winston Churchill
New nurses must achieve myriad milestones. Most new nurses breathe a collective sigh of relief upon passing their licensure exam. However, this period of jubilation leads to the next milestone, which includes securing one’s first position and then embarking on the transition from newly licensed nurse through the transition. This transition—which is somewhat akin to a rite of passage—may be smooth sailing for some, something akin to mountain climbing for others, and somewhere in between these two extremes for the majority. No matter where you fall, there are many strategies that you can undertake to facilitate your transition from novice to experienced nurse.
Securing a position in a supportive workplace will certainly serve you well; however, even if conditions are not optimal, there are certain things you can do to make things better. Follow these strategies to ease your transition into the workplace.
Engage in Self-Care
Nursing is a rewarding profession, yet it can also be quite stressful. Consequently, self-care is extremely beneficial. It’s important to get adequate rest, nutrition, and exercise. Other self-care strategies might include deep breathing and relaxation, yoga, meditation, aromatherapy, or journaling.
Utilize Crucial Conversations
As nurses we have no problem advocating for our patients, but it’s much harder advocating for one’s self. According to a 2009 study published in Critical Care Nursing Quarterly, 77% of nurses experienced disrespectful conversations but only 7% confronted the individual. Following the eight steps of Crucial Conversations: Tools for Talking When Stakes Are High can be quite helpful when dealing with challenging situations such as bullying or confronting a preceptor who is not being very helpful. These include:
- Get unstuck (assess the problem).
- Start with heart (identify what is holding you back).
- Learn to look (observe behaviors; identify stressors).
- Make it safe (respect personal space, use effective communication).
- Master my stories (stick to the facts; see both sides of issue).
- State my path (tell your story; be persuasive not abrasive).
- Explore others’ paths (compromise if possible).
- Move to action (develop a positive action plan).
Following these steps may not solve all problems, but they do offer a systematic, practical way to address difficult situations.
Use Effective Written and Verbal Communication Skills
You learned about therapeutic communication in your nursing programs, so be sure to utilize effective and professional verbal, non-verbal, and written communications. Oftentimes, misunderstandings occur because of miscommunication. Social media policies should also be followed. Other communication strategies include:
- Be a good listener;
- Avoid jargon;
- Speak clearly;
- Be aware of tone, rate, and cadence;
- Clarify and restate;
- Always reread your messages before sending;
- Pay attention to grammar and spelling.
Seek Out a Mentor
Mentors play a vital role in an individual’s professional and personal life. According to Fast Facts for Career Success in Nursing: Making the Most of Mentoring in a Nutshell, a mentor is someone who connects with and develops a reciprocal relationship with a protege and offers support and guidance. Finding a mentor can be challenging and requires one to be proactive and consider what one hopes to find in a mentor. You should approach the particular person with a formal request and a clear set of expectations.
Be an Advocate for Yourself and Your Patients
Patient advocacy comes natural to most of us; however, self-advocacy can be difficult. As a new nurse you will face some challenges and will need to learn self-efficacy, self-advocacy, empowerment, and resiliency. You can complete a resiliency quiz at www.resiliencyquiz.com. Learning the eight steps of “crucial conversations” can also be helpful to utilize when advocating for yourself and addressing issues such as bullying, workload, preceptors, and work environment. Your mentor can also offer guidance.
Improve Your Time Management and Organizational Skills
Perhaps one of the biggest challenges new nurses face is learning how to improve time management and organizational skills. As a new nurse it can be very easy to become overwhelmed as you leave the safety net of your instructors and are expected to manage more patients. Being punctual and setting the tone for the day will help keep you on track. Donna M. White, LMHC, CACP, recommends the following strategies to help you improve your time management skills:
- Create a “to do” list;
- Establish deadlines;
- Avoid multitasking;
- Reward yourself.
Develop Goals and Objectives
Developing daily, weekly, and even monthly goals is a great way to help you transition into your professional practice role. These goals can include a variety of topics. For example, you may include goals for improving time management, self-care, self-advocacy or clinical skills, critical thinking, and problem solving. A template for developing weekly transition goals can be found in my book, The Nurse Professional: Leveraging Your Education for Transition into Practice. When developing goals, you should also develop a five-year plan to help guide you through your transition and beyond.
In summary, the transition into professional practice can be challenging; however, there are strategies you can employ to help ease your transition.
Many recent nursing school graduates have recently started orientation as new graduate nurses. Orientation is a time that can be stress-filled, overwhelming, and even nerve-wracking. Below, I’ve compiled some of my favorite tips for new graduates embarking on their bedside nursing journey.
1. Bond with your fellow new graduates and cohort.
I am still so close with the new graduates in my residency program. Befriending the nurses in your exact position is embracing a built-in group of nurses who know exactly what you’re going through, and they can offer comfort and share experiences and tips. Debriefing with fellow new graduates and discovering they feel the exact same way as you do can be very validating. Make time to talk with your cohort, and make an effort to be each other’s cheerleaders on the unit.
2. Figure out who your resources are.
Your preceptor or clinical coach is an obvious resource for you on the unit, but I guarantee you there are others—a charge nurse, a CNA, a tech, or even a transporter or other clinical associate. Resources are people who have worked in the unit for a long time and can answer your many frequently questions: It may be where to find something obscure, a unit or hospital policy on a certain issue, or how to perform a clinical task. Also, just because you’ve graduated from nursing school doesn’t mean that books, manuals, and Dr. Google are no longer available to you!
3. Grow a thick skin.
It might be a terse comment from a doctor, a rude comment from a fellow nurse, or a patient who is ungrateful or angry, but I guarantee that something will upset you. Try not to take it personally. Remember that stress runs high on hospital units, and patients in the hospital are by definition not at their best. Try to grow a thick skin and move on.
4. Write things down.
Search for “nurse brain sheets” and find some that apply to your unit, or make your own. All that great note-taking you learned in nursing school can really pay off when you write things down on the job. If there’s a highly detailed policy or procedure in your unit for transferring a patient, for example, or a series of numbers to call to page dietary, write them down on a clipboard. You won’t regret it.
5. Get as much sleep as you can, and pack good lunches.
You may not be in control of your own schedule for a while, and that is both difficult and frustrating. Try to do your best to make sure you’re getting enough sleep before and after your shifts. If you’re transitioning to night shift, be sure to ask other nurses for tips on how to prepare. You are learning so many new tasks, procedures, and thought processes that sleeping after a shift is essential to strengthening the memories you’ve formed that day.
Although you may be too tired to grab a healthy breakfast or to grocery shop and pack a solid lunch, it’s imperative that you are able to keep your blood sugar high and your body fueled for your never-ending shifts. It’s no secret that nurses rarely get lunch breaks, so focus on snacks that are portable and quick and easy to eat on the run.
6. Try not be afraid to speak to physicians.
Learn how to speak to physicians in the SBAR format: situation, background, assessment, and recommendations. Effective communication is key to being a member of a care team and is critical for patient safety. Try to master the SBAR technique when speaking with physicians (and it is OK to have to practice what you would like to say before you pick up the phone!).
7. Cluster your care.
Time management will be something you work on for many months. In the beginning, the best you can do is try to cluster your care and anticipate orders. I used to think about it as “saving steps” — how can I walk one fewer mile today? What tasks can I group together? How can I go into this room only once instead of four separate times?
8. Timely documentation is absolutely essential.
Staying late to catch up on charting is a bad habit, and if you can stop that from the beginning you’ll be in better shape when you’re on your own. Try to document things as soon after you do them as possible so that you’re not constantly playing catch up. This is easier said than done, so be sure to ask your preceptor for his or her best documentation tips for your particular unit. One of my favorite tips is that if you have to check to see whether it’s been too long since your previous set of vital signs, just grab them!
9. Don’t be afraid to mess up….but try to only make the same mistake one time.
At some point, you have to realize you can’t wade into the deep end, and you’ll have to just jump in and fly solo. In the beginning of my own nursing career I remember being so terrified of making a mistake that I was virtually paralyzed by fear. This was not helpful, most especially in a code or critical situation! If you do make a mistake, forgive yourself, but try not to ever make that one again. Rely on your preceptor to catch you before a mistake reaches a patient. Formulating a trusting relationship with your clinical coach is also very beneficial.
10. You’ll never feel ready.
There will come a day when your preceptor and unit manager feel you’re ready to be on your own. When that happens, although you may feel like you are nowhere near ready, remember your resources. The first shift will feel out of control to you, but that’s OK! This is just the beginning of a long journey, and you will be a novice nurse for years. One day you’ll have a shift when things just click, I promise. Take deep breaths, focus, and remember to be the safest nurse possible.
Nursing is my newest passion; everything I do revolves around my life’s aspiration to become a registered nurse. This was not always the case as I once pursued a bachelor’s degree in English and Literature and spent years working for a regional newspaper until a sudden life change sparked an interest in the nursing profession. The years I have under my belt working for a community news publication has taught me a great deal about the power and impact of networking. I’ve learned that, in almost any career path you choose, it’s all about who you know. Making connections and establishing yourself as a credible individual in any field is an essential element to becoming successful.
My piece of advice for nursing students: Don’t wait to graduate–network now and network often.
There are many ways that you can get your name out there and make acquaintances with potential employers, or with people who may have tips on where to find the ideal job you’re looking for. Among the many avenues to network are:
Facebook – it’s not just for social networking; it can aid you in your pursuit for job leads and potential employment opportunities. To begin searching for groups and pages, simply type “nursing” in the search bar, and click on the “Pages” tab. This will result in countless groups and pages by businesses and nonprofits, as well as community groups. “Like” as many of the groups as possible so that your feed is full of news and postings that are of interest to you. If the group is closed, don’t be discouraged; I’ve never been denied a request to join any private page before. Many groups and pages have a list of related pages on the lower left panel under the heading “People Also Like” or “Liked by This Page.” It would be in your best interest to “Like” or subscribe to as many nursing-related topical pages as possible to be informed and up-to-date on the latest news in the nursing world. You can also get great tips about interview opportunities, such as on the RNInterview Tools group page. I have found myself engaging in conversations with experienced RNs and nursing students alike who are all willing and able to share their experiences and advice on becoming successful nurses. This information is priceless and readily available online.
LinkedIn – the professional’s choice social media platform. As someone with an All-Star profile strength status and a considerable list of connections at 3,100+ and counting, I have to say that my experience with LinkedIn has been fairly rewarding. I’ve communicated with thousands of individuals I otherwise never would have met in person. I’ve created professional relationships with people from all walks of life and from a wide variety of industries. I’m also able to follow certain companies and get the latest scoops on job opportunities or company announcements.
Organizations – join nursing student associations. I’m fortunate that my school has a very active nursing student association that encourages students to participate as early as orientation. Membership benefits include in a mentorship program, academic credit for participation, community service opportunities, workshops, and more. If your campus doesn’t have a nursing student association for you, there are state and national ones as well.
At school – there’s nothing better than meeting others face-to-face and starting an authentic relationship with potential employers. I have found that many, if not all, of my professors are full-time employees at major hospitals in the region. Ask individuals on campus who are faculty and/or staff that you come into contact with if you could keep their information as potential referrals. We are in the industry of caring and, in my experience, have had great luck approaching others on this subject. Some students are also employees at local hospitals and health care organizations that can keep their eyes and ears open for job opportunities.
These are just a few examples of great networking opportunities available at your fingertips while you’re in nursing school. Don’t wait until you’ve graduated to start making connections; establish professional relationships now to help you stand out later.
To address the nursing shortage in Arizona, the University of Arizona (UA) College of Nursing created an accelerated master’s program for people who hold university degrees in other fields. The only program of its kind offered in Arizona, it is 15 months long and offered in both Tucson and Phoenix. Reaching a record number of students, the Master of Science for Entry to the Profession of Nursing (MEPN) program enrolled 113 students last May, up from 98 students the previous year.
Nursing shortages are occurring nationwide due to increased healthcare demands and working nurses aging out of the profession. UA’s nursing program hopes to continue expanding to help fill the nursing workforce as well as facilitate students looking for a great profession. In addition to accepting more students into the accelerated master’s program, admissions to the program also increased this year from 220 to 260.
The MEPN might even be more appealing to some students because it is less selective than UA’s Bachelor of Science in Nursing program. So far, the program has enrolled students with a wide range of degrees from neuroscience to fashion design, with many students having held long professional careers before acceptance into the master’s nursing program. These older and more experienced students have a lot to bring to the table; their maturity and professionalism often translates well into nursing.
Students choose to make a career switch to nursing for a variety reasons, many of them being attracted to the stability that nursing offers or looking for a more fulfilling career path. The program is not easy, squeezing four and a half years of nursing curriculum and training into 15 months, and requiring students to complete 1,000 clinical hours. The program doesn’t remove any curriculum from the education that bachelor’s students receive, so students and educators are forced to operate in double time.
Most MEPN students don’t have time for outside jobs with their tight schedules of classes, labs, and coursework; however, the program does offer flexibility because students pursue a nursing career in an expedited way. This also allows for a more diverse student population like first-generation students who are working to support their families. The UA College of Nursing and the university’s department for Diversity and Inclusion are proud to train students to serve in diverse communities where medical needs are more profound. There aren’t enough nurses currently in the field to serve diverse communities in Arizona so it’s important to facilitate that need through this program.