Advice for New Grad Nurses

The day has come! It’s that first day that you are totally on your own at your first nursing job! No more clinical instructors! No more preceptors! No more agendas laid out for you! It’s all you! It’s a monumental day!

There’s nothing between you and your patients now. You are solely responsible for your patients’ care. You will be the eyes of the physician when he is not there. You are the advocate, the educator, the mercy-giver. You are the one the patient depends on. They will depend on your knowledge, your skill, your experience. Your decisions can mean their life or death. Your charting can mean your own professional life or death in litigation. And you will have nothing to depend on except that of what your instructors, preceptors, and teachers taught you…your experience.

No more clinical instructors. No more preceptors. No more agendas laid out for you. Its all you. It’s a monumental day.

It’s a paradoxical day.

The following story is my own. This is what happened to me on my personal version of that great day. I had gotten a job on a Telemetry unit in California and just finished a 3-month orientation for new grads. I had never been on my own before without another checking after me. Without someone as a resource. This is what happened:

I had gotten my report on my patients and started to make my rounds seeing each one…and doing my “head-to-toe” assessment like a good little nurse. I remember it was frantically busy. The other nurses were scurrying about like ants on an anthill. Patients were coming in on gurneys, the tele desk was alight with alarms and curly paper was being spat out in all different directions. The call light was continually screaming it’s alarm, and no one was talking to each other.

My last patient to see was a post heart cath patient who had been out of his procedure for about 5 hours. The protocol back then was to have them lie completely flat with an 8-pound sand bag on their groin over the insertion site for 8 hours…applying pressure to the site to prevent bleeding. I entered his room and greeted him, and found him looking rather gape-eyed. “I don’t think this is supposed to happen,” he said. And looking down toward his groin there was blood lining his sheets. He lifted up the sandbag and blood spurted out of his groin like a broken water pipe, making an arch across the room.

So…here was my opportunity to apply all that I had learned. To be the one who “knows what to do.” To make the choice that would make the difference between a critical situation, and everything being OK. Here it is. It all came down to this.

“Oh!” I exclaimed, “Let me go get the nurse!!”

Umm…Yes, I did that. I ran down the hallway and got the charge nurse who ran back to the room and applied pressure with her hands…and looked up at me like I was the complete idiot that I was. As soon as she looked at me, I realized, oh yeah, I AM the nurse. And quite frankly, I DID know what to do. I knew to apply pressure…I just…forgot. Or more accurately, I didn’t put all the book-knowlege, the clinical experiences, etc, to a practical use. I could have probably gotten that answer right on a test, but in the real situation?…

And I’ll tell you one thing… not a single care plan, out of the hundreds that I wrote in nursing school, helped me in that situation. Not a one.

Just saying.

So…I’m glad to say that I’ve grown over the years. I now know what to do when a patient is bleeding. 🙂

I tell you that story to make a point. I know that many nursing students come out of school with a specific specialty goal in mind, many being Labor and Delivery, and expect to go into it straight out of school. Many of you have contacted me for advice on how you can get in to L&D right away. I am glad that you all love my area so much, but you need to work on a Medical, Surgical, or Telemetry floor first. (Ah. I’ve just made some enemies.)

I’m afraid that in nursing school, you mostly learn how to take your boards You need to take the time to learn how to be a nurse. Go and put in some time on a Med/Surg or Telemetry unit. I would recommend at least two years to start. (Because it takes a year for you to figure things out, and another year before you truly can say that you’re comfortable.) Once you’ve done this you’ll have gained two very critical things. One being a good solid basic medical knowledge. (No, you haven’t gained that in nursing school…not the kind I’m talking about.) The other being development of time management skills. Without these being mastered, no matter what you do, you will struggle. And let me just say that trying to nurse without having time management skills is like being a bull in a china shop. You’ll hurt more than you help, and you just don’t belong there. If you can’t be good at time management, you will fail, plain and simple. L&D will teach you time management somewhat, but on a intermittent basis. Only a med/surg unit will force you to gain a grasp on having to keep up with constant infringements on your time and focus.

When you specialize, that’s just it, your knowledge is special…exclusive. In other words, you know a lot about a little. So before you do that, take the time to know a little about a lot. You will be oh so much more effective.

A pregnant woman in labor is a whole different animal than a non-pregnant adolescent or adult patient on the floors. They have completely different body system functions going on, all of which fall into the category of “normal.” When something happens that causes this abnormal “normalness” to become even more altered, the caregivers really need to be on their game. I have seen it time and time again, that a new grad nurse… who has limited experience and knowledge in the basics of Med/Surg…struggles. And what’s more, they don’t even know they are struggling. They just don’t get it…and they don’t know what they don’t get.

Now, I’ve known some new grads who have gotten hired straight in to L&D. And some of them have done just fine. It is possible to do. Most L&D units, however, will at least make you do a stretch of time on the postpartum unit before coming to L&D. It’s not easy to find an L&D unit that will hire new grads, so if you do want to go this route, I would recommend getting a job there as a tech, CNA, unit secretary, or of the like first, perhaps during nursing school, to get your foot in the door. I can pretty much say that it won’t happen otherwise. At least not at a hospital at which you should or want to work…in the long run.

So as Nike would say, “Just Do It!” Do the two years on the floor. Do it, and get really good at it. If you think that won’t take two years, then I’m afraid you’re overconfident. And one thing I can’t stand is an overconfident, yet green nurse. That’s a dangerous combination. Do it. Gain knowledge, get experience, become a resource. You’ll hate it, but you won’t regret it. And you will be better for it. Then, come to Labor and Delivery and you can focus on learning Labor and Delivery, and not trying to learn how to be a nurse as well.

And besides, you just can’t call yourself a real nurse until you’ve had to digitally disimpact a 97-year-old woman with dementia, screaming like a banshee, saying, “AHHH!!! It’s a wee cattle prod up me ars!!! GET IT OOUUUUT!!!!!” That’s just good times.


About International Nurses Association

The International Nurses Association was founded on the idea that professional achievement is deserving of recognition, exposure and reward. As a meeting place for the top minds in nursing, INA offers unlimited opportunities to further your success and embrace your role as a vital member of the medical community. INA is the fastest growing network of nurses from around the globe and takes pride in delivering its members the platform and competitive edge needed to survive in this ever-changing and complex environment. Visit
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