I spent last Friday morning at work crying. I was in my new job at my new hospital and in training. The training I took Friday morning was a mandatory two-hour computer-based session about the Commercial Sexual Exploitation of Children or CSEC. I cried with the testimonials and the trauma described by survivors and experts in the field. I felt a combination of rage and helplessness while I watched and listened to the videos. Luckily, I was in an area where no one else was sitting around me, so I felt I could express my grief and despair without too much concern.
I think this is part of what scares me about being a pediatric nurse. I worry if I can emotionally regulate myself when working with abused or neglected children. I also wonder and hope I can recognize and report abuse should I ever encounter an abuse victim. As difficult as it was, I appreciated completing the training and felt it was valuable. As a nurse, I am a mandatory reporter and must report child abuse when I suspect it. However, I think the general population should also take the introductory training about the Commercial Sexual Exploitation of Children to increase awareness, recognize and reduce risks, and maybe correct misconceptions about victims.
It is unlikely that the public would voluntarily take a two-hour training about the Sexual Exploitation of Children. Despite this, I hope to educate my readers and others who come across my blog or social media posts, because I think it’s important and is something I can easily do to help victims of CSEC. Some of the things I learned from the training are found below:
I can cry and grieve for these children, but I also want to take action. Let me know if you learned anything new from this post or if you found it helpful. I’m also curious to learn and hear from others about ways they support victims of the commercial sexual exploitation of children.
I have not posted in a while because I have been busy with some life changes. I recently resigned from my new grad RN job and accepted an offer to work at another hospital. What could have possibly taken me away from my #1 choice hospital and my highly pursued new grad program? A spot in my dream unit, the NICU!
It was tough for me to leave my program since I felt like the people were supportive overall. I truly appreciated the environment, community, and staff. I was learning a lot and growing as a nurse. However, my experience as a new grad RN working in the Float pool with adult patients also affirmed that my ultimate goal is to work with babies in a NICU.
My hospital has a NICU, which was a big reason I applied to their new grad program – I had hopes to move into their NICU eventually, especially after having a NICU preceptorship during nursing school. However, after working as a resident, I learned that the NICU at the hospital where I was employed does not accept inexperienced NICU nurses. The NICU manager recommended I apply to an L&D fellowship after my Float Pool residency, and maybe I could transfer to the NICU afterward. That would mean the earliest I could go to our NICU would be 2023, and that’s with the caveat that I would get accepted into a competitive year-long L&D fellowship. I would be competing with other nurses whose ultimate goal is to be an L&D nurse and other more experienced nurses previously rejected from the L&D fellowship.
After learning all this, I had the opportunity to interview during a mass hiring event for another hospital. The hospital already had my application from earlier in the year, one of the 70+ positions I applied to before starting my new grad program. I shared I only wanted NICU positions – there was no other reason I’d leave my new grad program since it was a great program in a good hospital. I interviewed with the NICU manager at the new hospital via MS Teams in between scheduled night shifts. At the end of the interview, she shared she’d like to hire me. I gave my job three weeks’ notice once I passed the background check and received a target start date. I started orientation for my nightshift NICU position at the new hospital on Oct. 1, last Friday.
I know it’s customary to give two weeks’ notice, but I felt obligated to give my old hospital three weeks. I ended up working four more shifts than if I had only given two weeks’ notice. During those four shifts, I had the most brutal shift I’ve had since coming off preceptorship and working solo. If I had left sooner, I could have saved myself from experiencing the most horrendous shift I’ve had so far. Luckily, my last shift was smooth and helped build my confidence after feeling torn down and broken from the week before – I met my patient’s needs promptly, charted everything on time, gave good shift reports, and my patients had no incidents. At my last job, I ended on a good note and had valuable learning experiences. My horrible shift in the week leading to my final shift taught me that when I’m overwhelmed, not only should I delegate, I should escalate to the charge nurse or nurse leaders. I will remember how awful my experience was on that shift to remind me in my nursing practice: “When Overwhelmed, Delegate + Escalate!”
I will remember this lesson as I start my new job. I am excited to have the opportunity to be in a NICU again. The children’s hospital where I precepted during nursing school opened its new grad program about a month after starting my previous job. Various cohort-mates encouraged me to apply, but I decided I needed to give my program and hospital a fair chance. I passed the opportunity to apply to the children’s hospital NICU new grad program before learning that my hospital would not hire me into their NICU for at least two more years. I don’t regret not applying to that NICU program because I’m grateful for my experience and feel more confident as a nurse because of what I’ve learned working with adults. I gave my program a chance and put forth my best effort, and concluded that I wasn’t willing to wait years to reach my goal to be a NICU nurse.
The earnest pursuit of career goals is somewhat new to me. For years, I didn’t know what I wanted. I knew that I was comfortable but not necessarily excited or passionate about my previous career as an engineer/scientist. During performance reviews, I would dread when my manager would ask what 5-year plan was because I wasn’t inspired by what was around me. I didn’t want my manager’s job, and other than becoming more skilled, building my expertise, and gaining more leadership experience, I wasn’t sure what else to say. Now, it’s nice to have a goal (dayshift NICU nurse) and work towards it.
It’s still a little terrifying: “What if I don’t like it?” “What if the staff is mean at the new hospital?” “What if it’s not what I thought?” “What if I’m not good at it?” “What if I can’t handle the long commute?” “What if I can’t last long enough on nightshift to make it to dayshift?”
Sometimes, you don’t know if you’re going to like something or will be able to handle it until you give it a try. I also have to be open to the possibility of failure or making mistakes with this new job – it’s those moments where real growth occurs, however. That’s how I became a better engineer or scientist. I made a mistake and remembered not to do it again. It’s like doing something wrong a couple of times before you figure out how to do it right, or in the most efficient way.
I think a terrifying part of being a novice nurse is mistakes in healthcare can have a profound and permanent impact on a patient and patient’s family. If I made a mistake as an engineer or scientist, many processes and people were in place that ensured no one would get hurt or injured. Delays or mistakes I made may cost hundreds of thousands of dollars, but they would never hurt someone. As a nurse, I no longer have that sense of security or protection. It’s anxiety-provoking. I’ve met many nurses with high blood pressure, anxiety, or depression due to the stresses of this profession. I don’t want to develop health issues because of my chosen career. I went into this profession to help people, so I try focusing on how I can help or improve care vs. contemplating the many ways I can injure someone or how someone may injure me (a genuine consideration with adult patients).
I’m still a recent grad with less than a year of acute care experience and still developing. Fortunately, my employer views me as a new grad and is willing to train me as a NICU nurse. I consider my new position as an opportunity to learn, grow, and be a better nurse. I’m going to try to focus on that and becoming the best NICU nurse I can be. Wish me luck!
I’m still trying to manage my life working the night shift while parenting a young child. While I wish I could engage more with my daughter, I’m grateful that she and my husband are close because of their time together without me. I wish I could give my husband more breaks from caring for our daughter solo. Unfortunately, I can’t participate in family activities like back-to-school nights or family dinners when I work. Truthfully, even when I do NOT work, I’m still exhausted from working night shifts; I can’t participate as much as I want with family activities, even on days off.
It’s a lot of effort for me to focus and maintain my clarity with sleep deprivation. When I started the night shift, I had difficulty sleeping during the day between my shifts and trouble staying alert during my shifts. I’m three months into working nights (7p-7:30a), and I can sleep about 5 hours between night shifts compared to the 3 or 4 I would get before. I am also more alert and have more stamina to last me throughout my shifts compared to three months ago. However, I now have difficulty sleeping at night on my nights off. (It was 2:30 on Monday morning when I started to write this blog post because I couldn’t sleep and wasn’t tired).
Here is how my day(s) off went after my last shift Friday night:
8:30 a – Come home from work Saturday morning, still stressed after a rough night shift – the third of three-in-a-row.
11 a – After showering, eating, and replaying my night in my head, I finally fall asleep – and miss out on my family’s Saturday brunch outing spontaneously scheduled with a friend that morning.
3:30 p – I wake up later than my 1p target. I feel too tired and groggy to join my husband and daughter for their afternoon pool-time.
7ish p – We have dinner delivered because I’m too tired to help prepare anything.
10 p – Husband wakes me on the couch since I fell asleep somehow. He convinces me to move to our bedroom.
2:30 a – Wake up and have trouble going back to sleep.
4:00 a – Take melatonin, hoping it will help me sleep
6:07a – The time on my clock that I remember seeing before falling asleep
7:35 a – The time I woke up when my daughter turned on all our lights and insisted on noisily searching our room for her lost unicorn.
My husband and I spent the rest of my second day off of work taking our daughter to gymnastics, having family brunch, going to church, and visiting a family friend in the afternoon and again for dinner. I briefly fell asleep sometime in the afternoon after reading with my daughter in her bedroom – before my husband woke me so we could go for the afternoon visit with a family friend. I try to enjoy days off with my family but often feel like a zombie days after I work.
When I work, I’m unable to attain the recommended 7-8 hours of sleep. I don’t think I’ve made up for the sleep debt I’ve incurred and am unsure when, if, or how I’ll make up for it. My sleep schedule is entirely abnormal, and I’m often tired. I schedule myself to sleep during certain times, but my body does not comply. I’ll fall asleep during the day between shifts hoping to sleep 6-7 hours but will often wake up after 4-5 hours. I have blackout curtains, use earplugs, play beach waves as ambient noise, spray lavender mist on my pillows and bedding, and wear a travel eye mask to help me sleep.
I don’t have television in my bedroom, and I take all phones out of the room when I sleep. I sleep for longer durations when I eat before going to bed in the morning, take melatonin, and supplement with tart cherry concentrate (which helps regulate melatonin levels). I set my alarm as late as possible before work and try not to look at my clock or phone until that alarm has gone off, even if I am awake and lying in bed for hours. I meditate or pray in bed to relax and attempt to fall asleep again if I wake up before the alarm activates. To stay awake while working, I drink caffeine but avoid it after 2a during my shifts and on days when I’m not working.
I’m not fond of the idea of having to medicate my body to either sleep or stay alert. In reality, though, I live in a caffeinated culture. Coffee and tea helped me survive nursing school. They also helped me in my first job as a nurse working swabbing shifts before 5:30a. Many people I know consume caffeine daily to be alert or as part of their morning ritual, and they are not nurses, nor do they work night shifts. Maybe I should accept that caffeine (and melatonin) are part of my weekly routine as a night shift nurse.
To try weaning off some of the caffeine, I’ve tried replacing some of my coffee intake with cacao. It has helped me during the early morning hours at work (when I think it’s too late to consume more caffeine), keeping me up without giving me jitters or hand tremors. My nursing school best friend turned me onto a brand, Crio Bru. According to Crio Bru:
“Brewed cacao is 99.9% caffeine free, but contains theobromine, a naturally occurring stimulant found in cacao that can be longer lasting, milder, and more pleasant than caffeine.”
It’s roasted cacao nibs that brew just like coffee, but there’s no caffeine. I like to make Crio Bru drink in a french press and keep it sugar-free.
I’ve also discovered a sugar-free cacao powder by ChocoVivo that doesn’t require a french press to prepare (https://chocovivo.com/collections/cacao/products/100-cacao-full-spectrum-cacao-powder). The hot chocolate from ChocoVivo has a thicker consistency since the cacao is not getting filtered out and is reminiscent of the hot chocolate I had with churros in Spain. It’s like drinking a dark chocolate bar. I sometimes like to add a little cinnamon to it.
I’ve been trying various techniques and methods to sleep or stay awake, stubbornly trying to make night shift work, because I eventually want to move out of my current position working with adults and work in a Neonatal Intensive Care Unit (NICU). I explored switching to dayshift when I met nurses from day shift in my cohort who wanted to work nights. However, I stopped pursuing dayshift with my manager when 1) the dayshift nurses changed their minds about working nights, and 2) I realized working the night shift was more aligned with my long-term goal to work in a NICU.
Because NICU is a specialty that people do not often leave, it is rare for any new NICU nurse to start work during the dayshift. One NICU nurse shared it takes ten years to switch to dayshift in her hospital because people never leave. I have no desire to work nights for ten years, but I am willing to work a couple of years on the night shift to work and gain experience in my dream unit. I know of a hospital in the area that supposedly has their NICU nurses move to the day shift in about 2-3 years, so my goal to to work there eventually. While I’m still adapting to working the night shift, I hope to adjust and thrive in a NICU. I’m using the time in my new grad program to adjust to the night shift, so I hopefully don’t have to struggle so much by the time I land in a NICU. I am making sacrifices now in order to reach my long-term goal to become a dayshift NICU nurse. Right now, the only way I know to get to days in a NICU is to start on nights. Hence, I continue to fight and search for ways to make night shift work for me and my family.
I would love to hear about your sleep hygiene habits and any tips for sleeping. Do you have rituals for bedtime or starting your day (or night)? What are your sleep routines? How do other parents of young children manage night shifts or graveyard shifts? What do you do to ensure you have sufficient energy while you work?
I have been working without my preceptor since the beginning of August, or for about three weeks. I’m lucky to work in a place that values teamwork and helping one another because other nurses have helped or guided me on almost every shift since I’ve been off preceptorship. One of the biggest things I’ve learned and the best advice I’ve received as a new grad is to ASKFOR HELP.
I have no problem asking for help or clarification when I am unsure how to do something. However, I get flustered when asking someone to do things for me when I think I can or should do such things for myself or my patient. At some point in my shifts, I may start falling behind, or the unexpected happens; if I want to stay on track or not be completely off-schedule, I must ask for and accept help and support. Other nurses have started IVs or completed bladder scans at the end of my shift for me, so I can finish passing meds or complete tasks for my other patients. While uncomfortable for me, I’ve learned to ask for help and accept the support and generosity of others. (Note to self: Never mess with a funky IV contraption that ED set up – it’s probably the only way they got it to work. Trying to “fix” it just before shift change can mess it up and cause you to lose IV access, requiring a new IV start as you scramble to do morning meds).
I’m on an exponential learning curve and make mistakes. Each week, I discover new ways of doing things inefficiently, incorrectly, or in ways that doctors, patients, or my manager do not prefer. [Un]fortunately, I am learning through experience and by doing. I make mistakes or feel so uncomfortable or irritated with my performance that I must consider various ways to improve or avoid making mistakes in the future to feel competent and more confident about my work.
I’m still learning how various doctors want to communicate with nurses during the night shift. Some doctors prefer secure chat, while others only want phone calls. I’ve learned preference, of course, because I’ve utilized the opposite method of communication to what some doctors wish to use. Meanwhile, my manager advised only calling doctors in an email that I didn’t read until days after sending numerous notifications to doctors via secure chat. (I now try to be more diligent about checking my work email). Ultimately, if I need to urgently communicate with a doctor about a patient condition or issue, I will use whatever method allows me to get a hold of them. I’ve also learned that it’s better for a doctor to be upset because I communicated something they thought unimportant instead of not sharing a potential issue with a doctor. Also, I need to document every attempt at trying to reach a doctor. I had a doctor upset with me for contacting him so late in the evening, even though I called his answering service multiple times, hours earlier.
Compare and Despair
To be clear, my leadership or staff have not shamed me for my shortcomings. My leaders have been genuinely supportive and offer non-discriminatory methods of correction. I don’t feel singled out by my mistakes, and I know I’m not alone when I speak to others in my cohort. However, I measure my success by using others’ progress as my ruler. For example, one of my cohort-mates calmly activated and engaged in rapid response for one of his patients on only his fourth day without a preceptor. He received accolades from the leadership team, and our manager shared his praise with the rest of our cohort. I was so impressed and in awe by what my colleague faced and how he acted in crisis.
In comparison, during my second week, one of my patients fell. I was getting the patient’s medication in the med room when the fall occurred. Falls require an incident report and are a pretty big deal for hospitals. Thankfully, my patient did not get injured and was apologetic for the fall. I felt embarrassed and ashamed for having an incident and kept replaying the scenario and trying to understand what I could have done differently or how much worse it could have been. I have been vigilant with my patients’ bed alarms and documenting their fall education since that event.
Discovering What I Don’t Know
I have done things in less than ideal ways and made mistakes and will likely make more mistakes. However, instead of dwelling on my mistakes, I can focus on continual improvement. Am I learning from my past actions or others’ mistakes? Can I figure out how to minimize the chances for errors or prevent making the same mistakes again? Can I improve on my processes or methods? As a new nurse, I have so much room for improvement and growth. I don’t even know what I don’t know, and I keep discovering this each week.
I recently learned that I needed to administer or waste narcotics within a specific time from retrieving the medication(s) from our Omnicell. For the past three months, I dispensed and gave narcotic drugs while likely exceeding this time limit because I hadn’t known this guideline existed. I had no idea until a nurse on the floor mentioned it to me this month, and my manager emailed the team after his periodic department audit. Now that I know about this limit, I try to avoid other tasks after pulling a narcotic that may prevent me from immediately administering the medication to the patient.
As I’ve shared in previous posts, I’m still adjusting to working nights and have had difficulty sleeping. I think it’s also because I’ve developed stress-induced insomnia: I replay how my shifts went and how I could have done better. I can beat myself up about things I didn’t know or events I wished I had handled differently, or I can use these experiences as lessons and move forward.
I write this blog to help others and because it allows me to process my experiences as a new nurse. It’s a way to release the ideas in my head so they don’t ruminate in my mind. My blog is also a reminder to focus on neutral or positive thoughts for self-encouragement and coaching. I consider how I would talk to a friend if they were experiencing what I was experiencing.
If you are a new nurse with anxiety before/during/after your shifts or beat yourself up over your mistakes, I am with you. Without realizing it, I survived the last night shift I had without caffeine; I think my stress response kicked in, and I was running on adrenaline. (Also, a unit secretary pointed out I was having hand tremors with the amount of caffeine I was consuming, so I’ve been trying to reduce my caffeine intake). I’m still figuring out the best ways to relieve my stress and practice self-care, just as I’m learning how to be the best nurse I can be. Besides lowering my caffeine intake, I try movement (yoga or hiking), meditating, blogging/journaling, or confiding in other nurses. It doesn’t matter how old, young, experienced, or inexperienced you are – there’s always room for growth and self-discovery.
This blog chronicles my nursing journey and serves as a journal of sorts, but I share my life to support and encourage others’ success and progress, too! I would love to hear from you: How do you give yourself grace while developing and growing? How do you move forward from mistakes? How do you practice self-care? For ideas, check out the past IG post I had about the Alphabet of Coping Mechanisms: https://www.instagram.com/p/B3uuR4ynB_9/
On my first day in Nursing Fundamentals Clinical, my instructor shared a typical schedule to follow when we’re on the floor and the expected flow of the day. My instructor explained how the nurse has to keep organized to ensure the nurse properly assesses each patient, gives medications on time, takes vital signs as needed, provides education, addresses orders, and documents care. One of my classmates asked how a nurse keeps track of everything, and my instructor responded, “Oh, I use my brain.”
My classmates looked at one another, perplexed. I wondered, “How will I hold all that information and remember everything I have to do in my brain?!?” Only later, with some further explanation from my instructor, did we realize the “brain” on which she was relying to stay organized is a document and not an organ in her body.
A nurse’s “brain” is a document that helps a nurse stay organized and allows the nurse to take notes for shift handoffs, doctor’s reports, or assessments. A nurse can also use a brain to track: treatment or surgery, when to give medications or perform additional tasks, inputs, and outputs, progression of care, or the completion of orders. Of course, the nurse documents care within a patient’s chart. However, a nurse’s “brain” serves as a mini notepad or planner for the nurse between charting.
In nursing school, I was exposed to and used various types of brains. There are numerous templates for brains available, and some are even free. During nursing school, I liked trying the brains offered by nursing.com. (With a subscription, the website provides a brainsheet database of 33 different brains, some focused on specialties like ICU, Peds, or L&D). Often, units in hospitals print specific brains for staff to use. However, it is the nurse’s preference that determines the brain a nurse uses. For instance, my preceptor never uses the unit’s pre-printed brains and writes out her brain every time she shifts. While nurses are not required to use a brain, I don’t believe I’ve ever met a nurse who doesn’t use one.
After attempting to use multiple brains, I decided to design my own. Some brains don’t have enough space, are not organized the way I want, or do not capture the information I need. As a new grad nurse, I find it difficult to track the completion of required charting or documentation unless I note it in my brain. No generic brain template is going to capture the documentation unique to my unit.
As I imagined what I wanted to include in the brain I was designing for myself, I read the book “The Checklist Manifesto: How to Get Things Right” by Atul Gawande. My husband received it as a gift, and he recommended the book to me. He thought it would interest me since the author was a surgeon exploring ways to make surgeries safer. The author worked with the World Health Organization (WHO) to develop a checklist to use for surgeries, to prevent errors (and ultimately, injuries or deaths due to preventable mistakes). It was a quick and fascinating read. He explored how other industries such as construction or airlines use checklists. As in surgery, errors in those industries can be fatal. At its worst, errors in construction or flying planes can be catastrophic and result in mass casualties. Yet, such errors are rare compared to mistakes in surgery. The book discusses how he and others developed a worldwide surgical checklist for WHO and what resulted. The author also shares when checklists are inappropriate and offers tips on developing them, even down to what font one should use. I enjoyed reading the book – it was a nice break from studying or reviewing nursing-related topics, yet I felt it was helpful to me as a nurse.
Considering what I learned from Atul Gawande, I placed a documentation checklist onto my brain template. Since I’ve set the documentation checklist in my brain, I’ve been more efficient in my charting. I can ensure I’ve completed the charting documentation for each patient without spending extra time combing through various sections of a patient’s chart to verify completion multiple times. My preceptor does not have to stay over later to complete missing documentation for our patients as she did earlier during my orientation and training. My checklist lets me know what I’ve done and what’s still missing during my shift. I know I’ve become more proficient at time management since starting orientation, but having the checklist helps me keep organized and manage my time. Plus, as a checklist gal, it feels satisfying when I cross off all the boxes in my checklist by the end of the shift.
Are there checklists you use day to day that help you in your personal life or your work? Or, are there brains you’ve used that you like? I’d love to hear and learn what works for others!
My daughter graduated from preschool last week. During her graduation ceremony, she wore a cap and cape. Instead of the traditional cap and gown, she and her classmates wore capes displaying their chosen super-power. My daughter’s chosen super-power: “I CAN DO HARD THINGS.” The next day, she started her summer camp at a different school. Her best friend from preschool is not attending the same summer program, nor will she follow my daughter to kindergarten. I was probably more emotional about my daughter moving into a different environment after two years with the same preschool teachers and classmates. Despite the mixed feelings I had, my daughter had a seamless transition. She was sad to leave her best friend and other classmates but genuinely happy and excited to be in a new space and meet new friends. My daughter shed no tears about the transition (unlike me). I agree; my daughter can do hard things.
My daughter is a big reason I push myself and powered through to pursue nursing as a second career. I wanted her to know it’s never too late to pursue your dreams and that it’s okay to struggle. When she is frustrated at not doing things perfectly or independently immediately, I remind her that she can do hard things. I allow her to work a bit and put forth the effort to try things on her own. I don’t swoop in to save her or fix things right away.
A recent example of this is when my daughter tried opening a package. She wanted me to open a snack pack for her, but I said she could do it. She then tried once and asked me to open it. Again, I said she could do it. She tried again and became frustrated that she couldn’t do it. I talked her through how she could try holding it a particular way to make it easier to open. She still struggled. I began to wonder if she had enough grip strength. I still cheered her on. She eventually opened the package herself. She was proud of herself. So was I.
Sometimes things take hard work and practice before we become good at something. As a new grad nurse, I identify with this. I do not feel confident or even competent some nights. I thank God that I still have a preceptor. However, it won’t be long before I’m on my own. I know I’m capable, but I doubt my ability to do things all on time or wonder how I’d handle a demanding patient-load independently.
I understand it can take a year or two before some new grads begin to feel confident or secure in their competence. I am anxious about cutting the cord, having my assignments, and nursing solo. But I know I can do hard things. I have done hard things and can continue to do hard things.
Growth and development come from discomfort and pushing our limits. Getting better at something won’t come from doing what feels easy. Like my daughter, I’m going through a transition. I’m in a new environment with new people and doing unfamiliar things (compared to when I was an engineer with 18+ years of experience in the same company and people who knew me).
Sometimes, I have to remind myself what I teach my daughter. It might be good for me not to have a preceptor to “save” me next month, just as I don’t keep my daughter from a bit of struggle. I know it won’t be without hard work, but hopefully, I can be proud of myself as an independent nurse. Maybe you’re like me and need the reminder, too: “YOU CAN DO HARD THINGS!”
This past week, I celebrated my birthday. It was not a milestone birthday, and I didn’t have a big party or gathering. I had dinner at a local restaurant and took advantage of their taco Tuesday specials with my family. My celebration was gluten-free, without added sugars, and alcohol-free since these are the guidelines I’ve chosen to follow to lose some pandemic pounds. (So far, it’s been working, even though losing weight is more challenging now that I’m older). I haven’t planned any big birthday celebrations for myself since going over the proverbial hill years ago. I get more joy planning my kid’s birthdays than my own these past years, so I wasn’t expecting or wanting a big bash.
However, I had to reflect and think about how grateful I am to celebrate another year of life. Not everyone gets to live long enough to be considered old. My friend’s recent death is a reminder of how precious life is. While I may be more mature than the average new grad nurse, I am not yet “old.” I plan to spend multiple decades as a nurse. As sad as it is to have patients ill enough to be hospitalized, I’m always impressed when I meet sweet, sharp-witted 90-something-year-old patients. I don’t know that I’ll live into my 90s, but I hope to live long enough to retire and take advantage of senior citizen discounts – my birthdays bring me ever closer to that goal!
Working with sick patients in a hospital makes me thankful for my health and getting older. I’m even grateful for simple bodily functions such as urinating or having bowel movements in a toilet. I’ve noticed some changes in my body (metabolism, eyesight, wrinkles, etc.) as I age, but I’m healthy overall. I’m on the other side of that hospital bed as a bedside nurse. I am well enough to start over in a new career where I can help others. This time a year ago, I was still in nursing school and about to start my preceptorship amidst a global pandemic. I have since graduated nursing school, passed my NCLEX, and joined my new grad RN program. I may be another year older, but I can still learn new things, adapt, and make meaningful contributions to others.
I didn’t celebrate this year’s birthday with a big group of friends at the Hollywood Bowl or in a backyard movie night as I have in years past. I had an intimate dinner celebration this year – I ate no cake and had no song sung to me by strangers at a restaurant. Instead, I was with family, in good health, and spent time with people who loved and cared for me. I chose how I wanted to celebrate and with whom. Coming off a pandemic year and reflecting on everything that has happened or what could be, I consider my simple birthday celebration a bounty of blessings. My birthday wish is for us all to be able to enjoy what we have in our lives, to recognize and share our gifts with others, and for peace and courage in pursuing our calling.
After I graduated in 2020, a friend once asked me if I would change my blog’s name since I was no longer a nursing student. I explained that while I’m no longer in nursing school, nurses must constantly learn and seek information like students. Nurses must update their license by taking continuing education courses and obtain or maintain certifications by regularly taking classes. Nursing processes or protocols are derived from evidence-based practices, which result from studies and research. With innovation and advancing technology, employers will require additional training or buy new equipment or software that nurses must learn how to use. There will always be something new to learn as a nurse.
I’m grateful for the classes during my orientation and training in my new grad program. My employer is taking the time to teach me and build my skills and knowledge by offering classes to supplement my preceptorship. My orientation classes are online (asynchronous or synchronous) or in-person. Often, the live, synchronous classes require pre-work before meeting with the instructor. However, we had a real-time virtual simulation earlier this week without pre-work requirements. There was no homework, but my takeaway from simulation this week is that I should review some of our policies or algorithms for specific situations. Taking classes does not make me an expert, and I’d rather be familiar with equipment and policies than floundering and doubting my actions in actual emergencies.
Overall, my new grad program classes are a good review and make me feel more confident and prepared as I shift and work with patients. Another resident in my cohort joked that we didn’t have to go to nursing school because our program taught everything we need to know as nurses! Regardless, I appreciate the review and the thoroughness of my training.
As healthcare providers, it is essential to remain curious and acknowledge we do not know everything. No one is perfect, and there is something to learn from mistakes and failures. Being a student implies a commitment to learning and continued growth and development. May we all be open to discovery and education regardless of one’s industry, profession, or age. Take on the mind of a student!
If you wondered what my calendar is like as a new graduate RN in a hospital residency program, this post provides some insight. I have classroom and skill sessions (didactic content) interspersed between 12-hour shifts at my hospital with a preceptor. The classroom sessions are more frequent at the beginning of the one-year residency. After the first month, there are fewer classroom and skills sessions and more shifts with a preceptor. Depending on the unit, a resident may have more or less didactic learning and preceptor shifts than other residents. For example, residents in the Emergency Department require more hours of didactic content and preceptor shifts than Med-Surge residents. I have 28 preceptor shifts for my particular unit and about 36 hours scheduled for didactic and hands-on skills sessions. The extensive orientation and formal training program are what attracted me to my hospital.
After the first 1.5 months, it seems the didactic portions take place about once or twice a month. My hospital hired me to work the night shift, and my preceptor works the night shift. During preceptorship, the resident’s schedule matches that of their preceptor. Some of my cohort-mates were hired into the night shift but have had day shift preceptors. It has been a new challenge for me, balancing working the night shift while trying to sleep and meet other obligations during the day, like spending time with my family or attending my daytime didactic sessions.
As a resident still on preceptorship, we’re not allowed to work overtime or during the holidays. This past week, I was unable to work Monday due to the Memorial Day holiday. However, I had work scheduled Tuesday through Friday morning and Saturday through Tuesday in addition to homework and exams I needed to finish. Sprinkled in my calendar are preschool pickups or drop-offs, grocery shopping, family outings, and other life events like my dear friend’s funeral. My schedule was as follows:
Sunday: complete homework/assignments Monday: Memorial Day holiday (not allowed to work) Tuesday: 8a-2:30p daytime classroom session (online) Wednesday: [7p-7:30a] night shift with preceptor A Thursday: night shift with preceptor A Friday: 10a – funeral/celebration of life mass Saturday: 4a-8a phlebotomy shadow Sunday: night shift with preceptor B Monday: night shift with preceptor B Tuesday: night shift with preceptor B
I mentioned my friend’s memorial mass to my preceptor Wednesday night only to ask where I might be able to shower or nap since the mass was at a church just down the street from the hospital. It wouldn’t be worth it to go home after my Thursday night shift and turn back around during rush hour traffic to attend my friend’s mass. After hearing my schedule, she offered to have me take Thursday off and reschedule that shift with her for another time. Initially, I refused, thinking it would reflect poorly on me not to work my total hours. Plus, I like my preceptor and did not want to reduce my shifts with her in the “shadowing” stage of my preceptorship. Yet, altering the rest of my schedule was impossible. I was determined to attend my friend’s mass in person Friday morning. I could not reschedule my Saturday shift since work already rescheduled it from the prior month due to the phlebotomist’s schedule. If I wanted to work the week of June 6, preceptor B was the only one available since my regular preceptor (preceptor A) would be on vacation that week for a family wedding.
As I sat there re-considering my preceptor’s offer to reschedule our Thursday shift together, I realized her offer was grace not often granted. As a resident tied to my preceptor, I’m not really on the schedule yet. My assigned preceptor is the only nurse listed on the roster for our shifts. Once I start working independently, it won’t be easy to take time off, especially since I’m only in my first year and have little paid time off accrued. I knew if I worked Thursday night, I would be drained and unable to rest Friday morning, which would add to me being an emotional wreck during my friend’s memorial mass. I returned to my preceptor and let her know I would take her up on her offer. I took Thursday night off.
I was grateful to be able to be present at my friend’s celebration of life mass. It was a blessing to be surrounded by those who loved her on Friday and remember her together. Unfortunately, not all those who lost loved ones during the pandemic had such an opportunity to gather in person. I was lucky that the pandemic death rate has slowed in our area, and churches loosened restrictions.
Part of the reason I became a nurse was to spend more time with my loved ones. I already worked 10-12 hour days in my previous job, but I worked five days a week. This past week’s events reminded me of how much I valued my loved ones and allowed me to create space for them and my well-being. I appreciate being a nurse, but I do not want work to come before loved ones (or my health) in my life.
It is Sunday afternoon. I need to be sleeping for my first three-sequential-night-shifts block, but I cannot sleep because I slept last night and have difficulty sleeping again during the day after a whole night’s sleep. I’m still figuring out a sleep schedule that works with my body. I’ve tried laying in bed, meditation, and prayer so I’ve given up sleeping today and figured I’d finish this blog post. I have never worked three shifts in a row before, let alone with the assigned preceptor (preceptor B) for the next three nights. I am nervous but excited to get a better sense of what it will be like to work three shifts per week as an independent nurse.
I am happy to announce that I got a job as an acute care RN and started my new grad program at a hospital! I did not post last week because I was in orientation all week and transitioning into my new role. I am thrilled to be part of my program since it is at my top choice hospital and provides comprehensive training. While I’m excited to share my good news, I wanted to discuss what led me to land a spot in my new grad program. I share my job search experience to offer encouragement, hope, and advice to future new grad nurses.
I applied to the same program after getting rejected the first time.
I got rejected the first time I applied to my program last Fall. The hospital did not even invite me to interview. I applied a second time to the new grad program in January, interviewed in March, and got an offer two weeks later. Some differences when I applied the second time:
I had gained several months of experience as an RN (COVID tester),
I had earned additional certifications to add to my resume,
I finally knew a couple of nurses working in the hospital, one of whom put in a good word for me to their manager,
I tweaked my application based on what I heard about the need and availability of positions; I emphasized wanting acute care experience instead of working in a specialty.
I applied to 74 RN positions before I got my offer at my hospital.
The new grad program at my hospital was the very first RN job to which I applied. I continued to apply to other positions, but I was narrow in my search. I focused on the specialty I was interested in and expressed this in my new grad program personal statements. After months of submitting applications and not getting any interviews, I expanded my job search to include Med-Surge/Telemetry positions. I finally landed my first acute care RN interview in a Telemetry unit. In the interview, I expressed strong interest in eventually transferring to a specialty unit within five years. I learned they were interested in me but concerned I wouldn’t be happy in the department and abandon them. They did not give me the job offer.
As my search continued, I learned not to narrow my focus to a specialty unit when I had no hospital experience. Once hired, it’s much easier to switch positions internally than to be an external hire. I still have a strong interest in the specialty unit. However, my priority as a new grad is to gain acute care experience and develop my nursing practice in a supportive and safe environment. In my new grad program, no specialty unit positions were available where I initially focused my search. Still, I applied and was determined to have a spot in the program because of the training and development I knew it would provide me. So far, I’ve been happy with my choice and have been learning a lot!
I worked as a COVID tester and vaccinator while applying to new grad programs and acute RN positions.
One of the 74 positions I applied for was a contract RN supporting studios as a COVID tester. Thankfully, I got the job. It was a great way to get experience working as an RN while still having enough flexibility to apply to hospital RN jobs and interview. More recruiters were interested in me once I became a working RN. Also, after working several months, my employer wrote a lovely reference letter for me that I submitted with my applications and included in my portfolio. A handful of positions required an employer reference. It was nice to be able to provide an employer reference from the healthcare industry.
I interviewed at five hospitals before I accepted an offer to join my program.
I applied to many acute care RN positions, with numerous ones at the same hospital or same unit but day and night shift positions. After applying, working, and networking, I eventually got invited to interview for some hospitals. However, most of these interviews took place only because I knew someone internally who advocated for me.
After unsuccessfully job searching on my own, I began to reach out to friends and family members in healthcare to let them know I was searching for hospital RN jobs. I also spoke with other nurses I met in my per diem job about their hospital jobs or connections. One of my coworkers got me an interview at her hospital! Most of the hospital interviews I had were because someone I knew convinced a hiring manager or director to interview me.
If you don’t know someone, it’s not impossible to get an interview. One of the interviews I had where I knew no one in the organization resulted in an on-the-spot job offer. I eventually turned it down and accepted a spot in my current new grad program instead.
I persevered after rejections or no feedback.
I applied to many programs or positions where I received no feedback for months or not at all – I would be listed as “under consideration” several months after applying. The first time I applied to my program in September, I didn’t receive my official rejection until November, months after my application submission. I tried contacting and leaving messages with some of the recruiters for other job submissions but would still get little to no response.
It was frustrating to hear people’s surprise at my difficulty finding a job: “Isn’t there a shortage of nurses? We’re in a pandemic – don’t they need nurses?” I had to explain that organizations need experienced nurses, and I had no experience.
My lack of experience working in healthcare was a disadvantage for me. I knew many of my classmates that quickly found jobs had prior healthcare experience working as surgical technicians, CNAs, Patient Care Associates (PCA), EMTs, or nurse extenders. The majority of my cohort completed their preceptorships at a hospital that used them after completing their clinical hours as nurse extenders or surge nurses in preparation for and during the COVID surge. I’ve learned if you can work in healthcare before you graduate, it’s much easier to find a job as a nurse.
Additionally, new grad programs were difficult to find or were highly competitive since many had been canceled or delayed. While I was disappointed at not getting accepted into programs earlier or not having acute care RN offers to consider sooner, I wonder if the rejections were God’s grace saving me from starting a job amid a COVID surge. A former classmate shared she cried before most of her shifts due to the deaths she witnessed. Another friend shared that many new grads in her unit were pulled off orientation less than two weeks into their training to help with the surge. In various ways, new and veteran nurses that worked during the surges were traumatized by the pandemic. If I had started working in a hospital sooner, COVID would have impacted my nursing experience in a much different way. In retrospect, I’m thankful for the rejections and disappointments in my life that led me to where I am today.
Never Give Up
I did not envision starting a job in a hospital almost nine months after graduating from nursing school. However, I trusted in my skills and abilities and knew that I had something to offer and had to keep trying. I was unsure of when or where I would work as an acute care RN, but I was confident in eventually getting a job somewhere and remained passionate about wanting to help people.
If you have a calling, go for it. If it’s truly your calling, opportunities will present themselves to you to lead you to your vocation, no matter how much you try to ignore it. The road may not be easy and may come with disappointments and rejections, but it might be what you need to direct you to your ultimate calling. Good luck on your journey!