“To do what nobody else will do, in a way that nobody else can do, in spite of all we go through … that is what it is to be a nurse.”—Rawsi Williams
Nursing is not an easy profession. There are so many pieces to put together, it can be overwhelming at times. After nursing school, there will be even more to learn. That’s where on-the-job training comes in.
Here are 15 things you can expect to learn on the job!
1. Learning To Chart Like a Champ
Charting is a skill like any other and it takes time to master.
You may be writing “The skin is moist and dry” for a while, but eventually, it’ll start coming more naturally to you. Follow your SOAP note format every time for the fastest path to mastery.
After you’ve received report using this Nursing Report Sheet, use it to write your SOAP note in the chart!
Ask yourself: “Am I taking a consistent approach every time I chart?”
2. Understanding Clinical Judgement
Setting priorities, examining the complexity of a task, and recognizing the next step to take will come as you develop your clinical judgment.
Tasks will vary and patient parameters will differ. Keeping all of these in mind while you learn, consider, and act is the growth of clinical judgment.
This Nursing Process cheat sheet may help you master the steps of the nursing process. With practice, it will come.
Ask yourself: “What is the first thing I need to do? Why?”
3. Recognizing When Patients Need an Intervention
You will develop this sixth sense alongside clinical judgment.
As a new grad, you will feel your gut yelling at you at times. It may take a while to tune in and listen to this voice, but you will learn. Your first reaction is usually the right one. Before long you’ll easily know when to step in for your patients in both routine and emergent situations.
Ask yourself: “What is the consequence if I don’t act now? What would happen?”
4. Mastering Time Management
If you think being a nursing student was hard, your first year as a nurse is likely to be harder. So hopefully you’ve mastered time management already.
It’s important to time manage because, as a new nurse, you’ll be doing everything a bit slower—it’s called the learning curve and everyone has one. Expect it but know that it won’t last forever.
Ask yourself: “Which action or task is most important? Why?”
Tips for Time Management
Cluster your care. Take the vital signs, then check your drips. Pairing these two activities will help you not miss anything and help the flow of your activities.
Ask yourself: “What other tasks can I cluster?”
Anticipate your next move. Being able to think ahead can help a lot. Knowing what medications to give at what time helps you know how much time is needed to prepare them before giving them.
Ask yourself: “What is the next action in this situation? Why?”
Anticipate the patient’s needs. One of the best ways of doing this is to listen to the patient. Patients know themselves and their bodies better than you do, so listen and trust them.
Ask yourself: “What’s more important for the patient right now?”
5. Taking Breaks, Even When You Don’t Need Them
When you have time, whether you need to or not, go to the bathroom, take a brisk walk, clear your head, eat a snack, drink some water, recoup yourself. Breaks are vital to increasing productivity and essential for mental concentration, both of which will help you manage your day better.
Ask yourself: “What’s most important for me right now?”
6. Navigating Family Dynamics
Even if you’re an extrovert who loves talking to people, this takes time. There are nuclear families, foster families, adoptive families, single-parent families, extended families, blended families, gay families, lesbian families, and childless families.
And the structure, the bonding, the communication, the boundaries, and the coping mechanisms are different for every family. It’s not your job to fix them, to be their spiritual counselor, or to be a social guidance officer.
But as their nurse, you are expected to be aware of their stressors and needs, to identify potential barriers to care, and carry out the plan of care within each family unit.
Ask yourself: “How can I be the best resource and communicator for this family?”
7. Seeing Yourself As Your Patients See You
As a nurse, you’re not their buddy next door, you’re much more. You’re their ever-present access to their healthcare and to their doctors. You have the answers to their questions.
You’re the hand they hold and the face they complain to. In 2020, nurses topped the Gallup Poll for the 18th consecutive year as Most Trusted Profession.
You’re the most trusted figure in the healthcare setting and this is a responsibility that our profession takes very seriously. Because of this high level of trust, nurses are held to a higher standard than the average professional.
Ask yourself: “Can my patients trust me?”
8. Knowing Your Worth As A Nurse
The healthcare system would be a shadow of itself without nurses. Nurses are the nation’s largest segment of healthcare professionals. With three times as many nurses as physicians, could you imagine a healthcare world with only doctors and no nurses? Of course not.
The whole healthcare industry would collapse without us. Nursing does not exist to assist medicine or other disciplines but instead to work independently, yet collaboratively, within a range of roles to ensure quality patient care. This is what makes nursing a profession in and of itself.
Ask yourself: “Do I understand my profession and my role as a nursing professional?”
9. Not Relying On Your Memory, Especially For Medications and Drips
One of the biggest mistakes I’ve seen nurses make is failing to verify.
Relying on your memory to give report, to modify medications, to receive report from a coworker’s memory will often lead to disaster. It’s possible to be a good nurse without a photographic memory. Best practice requires that you always verify. It may take longer, but it’s worth it.
Ask yourself: “For the safety of both my patient and my license, did I verify this?”
10. Using Routines To Make Life Easier
Eventually, the nursing process, including assessing patients, reading an EKG, and organizing your day, will become routine. It will all fall into place and what will get you there faster is a solid routine.
When you come onto your shift, do things in the same order every single time. If you can’t figure out a good routine, borrow one. Watch your veteran nurses. What are they doing first? Second? Third? Then make that routine serve you and make it your own. Create a checklist if it helps you and don’t sway from the process.
Ask yourself: “Does this routine work for me?”
11. Loving The People You Work With
When I worked night shift, I worked with an awesome group of people. I could have the worst night of my life with my patients, but because we were a team and they were supportive and positive, it didn’t matter how crazy the night got.
We spend a lot of time with our colleagues and they can truly make or break a shift. Work relationships can lead to strong friendships and solid support during rough times.
Ask yourself: “Am I a team player?”
12. Loving Your Patients But Knowing It Won’t Always Be Worth It
Hear me out on this one.
We care for every person, every patient, every time.
But there are those patients who just don’t care about themselves the way we care about them. For reasons we can’t figure out, mentally or emotionally, they don’t have the desire or ability to find a better way for themselves.
Eventually, we tag them as noncompliant, because no matter how much we care about some patients if they don’t care about themselves, it’s not a good use of our energy.
Ask yourself: “After much effort, is this patient worth my continued time and energy? If not, why not?”
13. Learning That Patients Know Stuff Too
Patients know themselves and their bodies better than you do. I’m not suggesting they provide their own nursing diagnoses or prescribe their own treatments. Rather, we should recognize the fact that they are experts in the wisdom and happenings of their own bodies.
It’s always wise to listen to them and trust them as best we can. We are approaching their health from a place of science but most patients are focused on what they believe, what they’ve read, and what they’ve heard. Most don’t understand science or medicine or nursing, but taking the time to hear them out and listen to what they’re saying between the lines, is important for providing quality care.
Ask yourself: “Have I listened to my patient? Have I really heard what he’s saying?”
14. Trusting Your Gut
As a new grad, you will feel your gut yelling at you at times. Intuition can be powerful, but you have to be open to it. It may feel like a hunch or an instinct.
Typically, your first reaction to something is usually the right one. But it’s hard to know that as a new nurse. Slow down and take time to listen to your inner voice and consider what’s going on inside.
Your gut can offer insight you won’t find anywhere else so be open to cultivating the process of training your mind, body, and spirit to trusting that inner voice. Your instincts are just as valid as anyone else’s.
Ask yourself: “What was my first reaction? Did I pay attention? And if not, why not?”
15. Discovering That On-The-Job Training Never Ends
You’ll always be learning and you will never know everything.
Ask yourself: “What can I learn today?”
Here’s to you, the successful nurse!
Cheers!
