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Although nursing students get a lot of practice while still in school—through clinicals, special training, and the like—making the transition from classroom to patients’ rooms may be a tough one.

Nancy Congleton, RN, BLS, PALS and ACLS certified, has been a practicing nurse for 17 years. She currently works at the Ascension St. John Urgent Care Clinic in Claremore, Oklahoma, and is the author of Autopsy of the NP: Dissecting the Nursing Profession Piece by Piece. We asked her about how nursing students can bridge this gap between their schooling and their first jobs in the field and other advice to jumpstarting their careers.

What are the primary actions/ideas that nurses should keep in mind as they move from nursing school to nursing practice?

Nurses should keep in mind that they may not get the exact job they want as a new nurse. Here’s why: For one, while the nursing shortage is indeed broad, there are certain areas (especially within a hospital) that are popular and don’t frequently have open positions.

Also, there are some nursing specialties that require nurses to have previous bedside experience prior to applying. Within a hospital this can be the case with ERs and critical care areas. Outside the hospital, this can sometimes be the case with home health and hospice companies; they don’t want a nurse to be out in the field caring for a patient by themselves if they don’t already have a baseline of experience.

If you have to take a job in an area that you’re not particularly fond of, work hard, learn all you can, give it six months, and if it hasn’t grown on you, see if there’s an open position in your preferred specialty.

What are the most common challenges that nurses have in bridging the gap between nursing school and working in their first jobs? How can they overcome them?

In nursing school, students learn about one disease process at a time; one complication at a time. But in the health care setting, they’re caring for multiple patients with multiple co-morbidities. It is normal to feel overwhelmed and to feel like your head is swimming from everything that was crammed-in during nursing school.

And while nurses do have a license to practice, that doesn’t mean they remember everything from school. To help solidify your knowledge while working, I highly recommend having nurse pocket guides on hand. These serve as quick and concise reference guides. There’s several available: MedSurg, Critical Care, Psych, EKG, etc. For the convenience and what you get, they are well worth the investment.   

Also, in the early stages of one’s career, I recommend nurses jotting down anything they come across that they’re not familiar or thoroughly comfortable with. Later, look those items up and take notes.

Another challenge new nurses face is being completely overwhelmed with how many tasks need to be accomplished; this is especially true if you’re working on a busy floor.

Here’s the rule of thumb to survive this: Whatever patient or situation is most critical or has the potential to be most critical, you address first. For everything else, put one foot in front of the other, knocking out one task then another, and repeat until everything’s done.  

And lastly, a common challenge new nurses face is being inundated with questions from patients and their family members, and, more often than not the nurse doesn’t know the answer. This is okay! Even seasoned nurses are sometimes presented with questions they can’t answer. Just be honest, tell them you don’t have the answer but that you will find it and get back to them. And then do it!

If nurses find that they need help when navigating this first job, whom should they reach out to?

Their preceptor: The nursing profession places a heavy emphasis on utilizing the chain of command, so you want to start there. If a new nurse feels like their concerns are not being heard or responded to, the next person would be the floor/department manager.

What are nurses most concerned with when they are moving from school to practice? What can they do to alleviate their fears?

Many new nurses are concerned that they will mess up or miss something critical and will kill or harm a patient. Here’s what I recommend: Do not give any medications that you are not familiar with. Look them up and make sure you know and understand what they treat, possible side effects, adverse reactions, contraindications, and any needed patient teaching.

Next, any patient with a disease or condition that you’re not familiar with (whether it be their main diagnosis or just listed on their medical history), look it up and learn what complications are common for that condition and be on the lookout for them.

Additionally, any patient that has any abnormal vital signs or lab findings, move them to the top of your list in terms of completing their assessments first and checking on them frequently. This doesn’t mean that you ignore your other patients; you’re just prioritizing the care you give to focus on the most critical (or potentially critical) patients first over patients who are medically stable.

After doing all you can to be proactive, follow that with asking for help anytime a situation presents where you are uncertain what to do. In the beginning months, as a new nurse it may feel like you’re being overly-cautious, and you might even illicit a few chuckles from seasoned nurses but that’s okay. They’d rather you be over-protective of your patients, than miss something causing harm to a patient.  

What should nurses keep in mind to have the most success in their new careers?

Nurses should keep in mind that nursing school lays the foundation for their practice, but it is up to them to build on it. There’s simply not enough time in nursing school to cover everything. Therefore, when a new nurse chooses an area to practice, they need to thoroughly study all applicable textbooks related to that area. For example, if a nurse’s first job is on a pediatric floor, it would be highly beneficial to study the pediatric textbook cover to cover.

Later, if the nurse transfers to a different area of nursing, this process should start over.

What are the biggest mistakes they make that they should be aware of and try to avoid?

The biggest mistake a new nurse can make is to burn a bridge with a hospital by not giving the required resignation notice or worse, none at all.

I’ve heard of nurses who’ve hired on at a doctor’s office and had such a horrible experience that they resigned with no notice given. If it was truly an unbearable situation and the nurse knows they will never seek employment there again, they’ve lost nothing. Burn that bridge!

But, if a nurse burns a bridge with a hospital, they’re not just burning a bridge with the department where they worked. If a nurse fails to give a proper notice, most hospitals will put them on a “do not re-hire” list. Since hospitals have multiple departments that employ nurses, that nurse is actually eliminating anywhere from seven-to-twelve different possible job opportunities that they could have at that hospital at a later time. This equals a great deal of missed possibilities for years to come.

If a new nurse feels they absolutely must move on, provides a two-week notice and then is confronted with an exit interview, they should not in any way bad-mouth the manager, department, or the company.

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