There is an interesting mix of emotions that occur when you first qualify as a Registered Nurse. Initially there is the euphoria of passing all the examinations and the relief of being paid a living wage, there is the pride of achievement and the excitement of a new job. These positive feelings are soon mixed with the stresses of working in a new clinical team, being in charge and responsible, feeling that you should know everything, giving ‘handovers’ and the loss of your student group peer support and university mentors.
Some nurses find this transition from student to staff nurse relatively easy, others find it difficult. Some newly qualified nurses who 3 years ago were healthcare assistants (HCAs) have the additional challenges of returning to their original clinical area, but this time as a qualified nurse. Whatever the background and personality of the newly qualified nurse, everyone will find those first few months challenging, stressful and demanding. It is important to appreciate that although the change of role from student to qualified nurse is relatively instant at the point of ‘registration’, the adaptation and internalisation of the role takes a few months. Those early weeks can be pivotal in forming your identity as a qualified nurse. Consider some of the following key areas that you will face in your first months.
Your new role within a team
If you are working in a hospital ward then there will be HCAs—some of whom may have been working there for a decade, while others will be new and inexperienced—there will be other experienced qualified nurses, a ward manager, junior and senior medical staff, a variety of other health professionals, administration and domestic staff and student nurses. You find yourself amid that complex collection of professionals and support staff. The nurses in that team will recognise your vulnerability and support you via the normal preceptorship guidelines, but most of the other people, including the patients, will just see you as a qualified nurse. You will have to work out very quickly how you relate to people of varying experience, qualifications and roles. You will have to make decisions that you have not previously made, give directions and allocate jobs to people who, although not qualified nurses, are more experienced in the routine of the ward than you are. Two fundamental pieces of advice I give to newly qualified nurses working in complex teams are: always be willing to ask for advice from any members of the team, be they medical consultants or HCAs, and respect each person's role within the team.
Developing your knowledge base
Your 3 years as a student will have given you a lot of factual knowledge. That knowledge now forms the scaffolding of your future development as a nurse. For starters, you will need to develop very quickly your recognition of any ‘red flags’ in your clinical area—such as sepsis, infection or changes in consciousness—and the procedures for highlighting and managing those emergencies.
There will be a number of daily routines that need to be remembered; these range from the organisation of coffee breaks to the checking of the emergency trolley and equipment. I'd suggest buying a blank note book and listing the routines under key headings or times. There will be many specific procedures associated with the clinical area, whether relating to admission, discharge, checking medication storage, referral for various investigations, wound care or many more. Most of these procedures will be written down in folders or on the intranet and you need to make sure you are familiar with and following such guidelines
As a newly qualified nurse you will need to increase your knowledge relating to the clinical conditions of your patients. For most nurses this will mean buying an ‘all you need to know’ book on orthopaedics, or gynaecology, or whatever your clinical area is. When you have been on the ward for 6 months, you should have a reasonable understanding of all the common clinical procedures of that speciality.
Seeking help and support
No one expects a newly qualified nurse to be as efficient as someone qualified for several years, but sometimes when you are that newly qualified nurse it doesn't always feel that way. It is important, in those early days, to find someone to give you honest feedback and support as you make this important transition. That support may come from the person in charge of your preceptorship programme, or a more experienced nurse. If you are finding a particular aspect of your new role difficult, make sure you seek help and support.
Work–life balance
Although it is important to focus on developing your clinical experience in those first few months, it is also important to establish a good work–life balance. Although it will be tempting to take home the stresses of your new role, try to leave your work at work. How you do this will depend on your family commitments; some form of active sport helps clear the mind, or some people find yoga or pilates relaxing. It is important to develop good habits that look after yourself and your family as well as your patients.