A Letter to my New Graduate RN Self, 17 years later
There are many things that I have learned in working as a Registered Nurse since 2006. The amount you learn in nursing school and with your RN experiences is unfathomable. This is a letter to my earlier new-graduate nurse self. This is what would have been comforting to know and understand. For any new graduate nurses out there, listen up, take note, and don’t be too hard on yourself.
As a new nurse, you will be task oriented. This means that you will focus on completing items that are tasked to you during your shift. You will administer all medications at the required times. You will complete the physician orders for your patients within the time frame needed and document all items appropriately in a timely fashion. This all sounds great, you are doing the job you have worked so hard to achieve. Here is what you are missing. You are so focused on the tasks and keeping your new Registered Nurse license intact that you are not quite able to view your patient or resident holistically. You complete your head-to-toe assessments properly and thoroughly, but that is it. This is OK! In a year or so, you will complete your assessments while conversing with your patient and their family or friends. Over time you will talk to your patients as you would an acquaintance because your confidence has increased to the point where you can give a greater piece of yourself while you engage more deeply with them. This more profound connection with your patients sets you apart from your new graduate nurse self.
You are likely going to struggle with delegation. Even though you learned proper delegation in school and are even tested on it with your NCLEX-RN, applying it in action takes practice. Many of you likely went from being in a supportive role. Remember to be respectful to the support staff and responsible for your patients. You will see nurses who are great at delegating and questioning the acts of others. Be considerate. When another nurse has a busy shift and the support staff has to assist them more frequently, perhaps you can complete more delegatable asks (ambulating, call lights, bed bath, vital signs, etc.). In turn, when you have a patient load that is higher in acuity, you will need to delegate. This ebb and flow are what makes for an excellent work team. Never expect someone to do something for you unless you ask. You will learn how important it is to check in with your support staff (CNA, MA, tech) at the beginning of your shift and review the patients’ or residents’ needs, requests, and items you would like to do together. For example, bed baths and bed change so that you can assess the patient’s skin in detail if they are a 2-person turn.
Do not stress out over documentation. Yes, you must abide by the policy at your healthcare facility. For example, your cardiac telemetry unit requires a head-to-toe assessment and vital signs every 4 hours, which you are doing. However, you have six patients during your 12-hour night shift. Two patients have new onset of chest pain, which means numerous interventions, communication, and documentation. Two of them have Pneumonia and receive treatment from Respiratory Therapy (RT) and scheduled IV antibiotics from you. The other two patients post cardiac catheterization need frequent groin site checks, telemetry monitoring, and documentation. Overwhelming, perhaps, but you are assessing them as ordered and per policy.
Here’s the thing you don’t realize. Sitting down to document all items immediately after doing them is NOT necessary. Yes, you heard me! What is more important is continuing to monitor and stay with your two chest pain patients. An excellent addition for the nursing staff is bedside computers. You can document and be with your patient. It didn’t use to be this way. When your patients are stable, go ahead and document all of your assessments. Here’s the secret: make sure to note the time you assessed your patient, as that is when you will put it in the electronic health record. You are a better nurse for staying with your compromised patients at their time of need rather than rushing to document and possibly missing an ST elevation, stat lab results, or your patient going unresponsive. You will eventually do this all seamlessly without blinking an eye. In fact, YOU will care for your six patients, be the charge nurse, and help other nurses with issues and questions with their own patients. No, I’m not joking, you will be this nurse, and this is when it really gets exciting!
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