newgradrn – The Mature Student Nurse

Major Update: I Quit My Job!

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!

Staying Organized: Brains and Checklists

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.

The documentation checklist I added to my nursing brain

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!

Why I’ll Always Be a Student

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!

Never Give Up: My New Grad RN Job Search Experience

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!