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Every year, brand-new nurses enter medical circles across the world – donning scrubs, clipboards, nursing shoes that help them be on their feet longer, and a heart full of excited trepidation. For most nurses, their first year is the most exciting – and terrifying in their whole profession.

Gone are the days of simulation labs and clinicals; now real lives are in their hands.This often overwhelms and alarms newly registered nurses, many of whom may choose to abandon this line of work because of an inability to cope or balance real-world risks and pressures.

That’s why this article will detail the most prominent challenges that graduating nurses will encounter when they start their first job. Study these possibilities, so that you know what’s coming when stepping out of your classes and into your workplace.

1. Physical Strain

The nursing profession is hard on the human body. Once you start working as a nurse, your body will hurt after almost every shift. Expect to be on your feet for most of the day, not to mention rushing around the hospital, lifting patients and equipment.

Expect to experience serious physical discomfort, especially in the first year when your body is not used to it. To combat this, follow a self-care routine (diet, exercise, stretches) beforehand. Stretch regularly. Purchase and wear compression stockings. Invest in good-quality shoes made specifically for healthcare professionals.

Klaus Nielsen — As a practicing nurse, you may have to deal with biases from colleagues as well as patients. Remember to open up about them with someone you trust and discuss ways in which you can overcome them.

2. A High Learning Curve

Nursing school teaches you many valuable skills, but nothing can replicate the real world. What is learned in school is at most, basic when compared to the situations, an actual hospital will throw at you. Expect a high learning curve in all spheres of not just your specialty, but of your day-to-day life in your workplace.

Nurses have to deal with multiple emergency situations, which will be terrifying without experience. They will need additional in-service training in multiple competencies: basic life support (BLS), advanced cardiovascular life support (ACLS), using electronic clinical management system (CMS), entry of in-patient medication order (IPMOE), performing venipuncture and blood extraction and much more.

Be it studying and practicing technical skills, figuring out the nuance of team dynamics and communication between colleagues or the standards for presentability expected by your employer, you will have to expend yourself to absorb more knowledge and apply it practically.

Wildan Zainul Faki — Do prepare yourself with what real world nursing entails after you graduate with your nursing degree

3. Orientation on Protocol

Every hospital and medical facility has a distinct set of operational protocols. This doesn’t just apply to global, national and state-level medical regulations the particular establishment must follow. It also refers to both passive and active protocol systems put in place by individual healthcare institutions. All first-year registered nurses (RN) must attend detailed orientations on protocol, as well as extensive documentation they have to study and commit to memory. They will have to adhere to these protocols in all situations, especially emergencies. That means they have only about a couple of weeks to learn what guidelines and regulation their work will be subject to.

Joshua Macknight — Wear your nursing badge of honour proudly, it’s been a tough road training to be a nurse, and you deserve that respect.

4. Workplace Bias

Expect to run into some measure of workplace bias. Work cultures vary between employers, but in a high-stress environment such as healthcare, hierarchy and bias can be more emphatic. In their first year, RNs might face alienation from some seniors. This can be difficult to work with because new nurses need all the guidance they can get. Since good relationships with colleagues enhance one’s sense of belonging and facilitate self-development, the lack of it can be disheartening and create additional pressures on the individual.

Nurses can also be affected by bias is also a factor in nurses’ daily interactions. Bias can occur on the basis of almost anything – religion, culture, ethnicity, gender, etc. As an example, have a look at this account by a male nurse who relates his experience with a young patient and their mother.

“As I introduced myself to the mother of my patient, a three-year-old boy, I noticed that she seemed hesitant…..As we talked about his favorite cartoons and after he seemed more comfortable and started engaging in play, he started to trust me and even tried to take his medications. When I returned to check on him later, his mother seemed less tense and opened up about several issues that she did not fully understand and were concerning her. Later, she told me she was initially concerned about how a male nurse would interact with her son because, in her culture, men were not associated with being compassionate or emotionally expressive.”

5. Team Dynamics

This paper on the challenges of fresh nursing graduates during their transition period reveals that new RNs were hesitant to ask their seniors for help about clearing up their uncertainties because they were anxious about being criticised for insufficient knowledge. Participants in the study reported being criticised after committing minor mistakes.

While you are expected to work independently, you are also going to work in collaboration with other RNs, supervisors and doctors. They come with their own experiences, preconceptions and expectations from new joinees. Some of them may not have the patience for gently guiding graduating nurses. There might be some friction, which new RNs will have to work through without aggravating everyone else. Since they are at the bottom of the workplace hierarchy, they might face their share of unpleasantness on the job.

6. Patients’ (and their Families’) Expectations

Patients and their families do not care (or know) that you are new on the job. They see a nurse wearing the uniform, they assume that he or she is a professional who can answer their questions and tend to their needs. Every RN, no matter how experienced they are will have to deal with patients, relatives and everyone else in the ward.

Patients are often stressed and panicked, as are their family members. They are mostly frantic about having their questions answered and trying to find assurances about the health of their loved ones. First year nurses will have to learn to comfort them, and sometimes, convey bad news. They will have to learn how to endure and defuse emotional outbursts with compassion – all while providing appropriate, timely care to those who are sick and scared.

7. A Massive Workload

Every graduating nurse will experience a heavy workload. The average ratio of nurse to patients is 1:12, whereas the highest ratio is 1:21. Their workload entails reams of never-ending paperwork as well as managing multiple activities at the same time. Some of these tasks would be providing doctor-prescribed treatment after every round, answering patients, monitoring medicine intake of patience, etc.

Joshua — Remember your job as a nurse is one that the whole world is grateful to you for pursuing!

Most hospitals and medical institutions are understaffed. Working with insufficient manpower will increase workload, and consequently stress. This is particularly true of nurses in their first year. It is not uncommon for them to work overtime, pull all-nighters, miss meals and have to forego some sleep.

Undoubtedly, your life as a nurse will be exhausting and seem thankless once in a while. But, you will also be one of the most important people in the world, saving actual lives every single day. Obviously, walking this path won’t be easy. But with the right tools and training at hand. It will be the most worthwhile thing you’ll ever do.

In the field of nursing, simulation training is one of the most effective ways to increase efficiency and familiarize student nurses with daily and rarely occurring medical scenarios. Nurses engage in simulation training to get master chief procedures such as inserting a catheter or tube. They are expected to perform similarly delicate tasks with great competency in highly demanding environments. Simulation training can help prepare for such scenarios. As per Christine Park, M.D. the 2017 President of the Society for Simulation in Healthcare, simulation training has three core benefits that include, “competency in technical skills, integrating cognitive and psychosocial skills into patient care, and enhancing team communication skills in a clinical environment.”

RFS Studio — *Simulation using models, drawings and mannequins help students succeed in real-world medical settings*

To understand better, simulation training is an educational approach wherein a real-life experience is replicated or amplified in a controlled environment. It makes for an interactive and immersive learning experience through practical application of learned theories. The first mannequin was built in 1911 to train nurses to perform physical tasks such as dressing, turning, and transferring patients. Over time we have progressed to computerized mannequins that can imitate the body’s physiology. Simulation training has also been integrated in numerous nursing programmes such as those for mental health specialization or end-of-life care, etc. Anatomical simulation is an area of virtual reality that allows students to visualize patient anatomy by ‘virtually dissecting’ them. Immersive virtual reality is currently represented by two major companies, Oculus, which makes the Oculus Rift, and HTC, which makes the Vive. Simulation training has also been integrated in numerous nursing programmes such as those for mental health specialization or end-of-life care, etc. Nursing institutes have started incorporating digital and game based simulation techniques such as Bodhi Health’s MEDGAMES and MEDLEARN virtual simulation platform for nursing students to practice procedure-based skills or conduct skill-based assessments.

Doctor in operation room — *Simulation based surgeries allow students to gain practical knowledge of their theoretical study*

A well-constructed simulation training programme can help student nurses experience “what if” scenarios, attain a problem solving attitude, manage crisis better, and observe the effects of techniques employed – all without repercussions. For the aforementioned reasons and more, simulation training plays a central role in nursing education. To ease out the process, we have created a reference checklist before you initiate simulation training for student nurses:-

Ensure You Have Secured the Required Permissions

Simulation testing demands professional and ethical behaviour. Educators need to ensure that there is mutual respect, confidentiality, willingness to accept and share constructive feedback, and that the performance is consistent with the institution’s policies. Prepare a fiction contract that outlines the importance and mutual agreement of performing as if in a real clinical situation for the benefit of fostering an engaging learning experience. A talent release is a mandatory legal document you require to receive consent of photography and videography during the training.

Nurse taking blood from the body. — *Simulation increases a medical student’s adeptness at performing delicate and critical tasks*

Define the Purpose of Your Simulation

Healthcare simulation scenarios are created to address specific learning needs. Before creating a simulation, it is important to decide what information is needed and which part of the operation should be replicated to meet the objective. As stated by the International Nursing Association for Clinical Simulation and Learning (INACSL) the first step in scenario development is the completion of a need’s assessment. INACSL’s simulation design standard provides a sequential checklist for scenario development which can be used by clinical facilities, medical schools, and in postgraduate medical education. Once the learning objectives are clarified, it becomes easier to attain them through simulation training. Make sure that the objectives identified are limited in number and are specific or they might frustrate the learner and make the assessment complicated.

Doctor checking pulse — *Simulation training helps build a medical student’s ability to be more empathetic, patient and caring*

Define the Metrics for Evaluation and Assessments

Simply creating a simulation lab space does not ensure that the best training practices are incorporated. While self-confidence can be argued as a measure of assessment, there are other methods to enhance effectiveness of the education strategies. Kirkpatrick model of training effectiveness is the most commonly used evaluation framework which includes four levels of assessments:

Reaction: The satisfaction derived from the training
Learning: The increase in the skills and knowledge of the student
Behaviour: The observed changes in the behaviour of the participants
Results: The outcome of the simulation

Applying the aforementioned framework can help an educator measure how well the simulation training worked and how much it improved the learner’s knowledge, skills, ability in a medical setting. Training facilities could also create a survey to measure the effectiveness of the simulation training.

Conduct Pre-briefing and Debriefing sessions

Efficient communication is the cornerstone of every learning experience. To enhance the effectiveness of the simulation-based training, conduct a pre-briefing session prior to the hands-on lesson through orientation tasks and learning engagement activities. This would enhance learner satisfaction, participation, and effectiveness of simulation practice.

Debriefing sessions are conducted after the simulation to underline the thought process which would help improve future performance. Incorporating this practice as a habit would help both learners as well as educators to re-examine the simulated case experience, share their mental model, and foster the reasoning behind their clinical judgment.

Prepare the Instructors and the Learners

To ensure a seamless learning experience, it is important to prepare the instructors before the simulation. Organize simulation review materials such as learning objectives, equipment setup, expected interventions, vocal scripts, debriefing points, etc.

Discuss the expectations from the simulation training scenario with the learners. This includes assigning roles and responsibilities such as the lead medic, PC operator, facilitator and the team members who would assist. Remind them to treat the simulator as they would a real patient – with respect and empathy. Explain to them that while the simulation would largely imitate a life-like scenario, some things may appear artificial, however, for the sake of learning, they are to be overlooked.

Consider the Disadvantages

Constructing a healthcare simulation from scratch is a daunting task that can get complicated with limited funding. Nursing state boards and other accrediting bodies expect simulation programmes to follow recognised national standards, which can be hard to get right in the first go. As discussed, it is also difficult to measure the results from simulation training to gauge whether it was successful or not.

However, despite these initial hiccups adopting simulation training far outweighs its drawbacks. The trial-and-error approach through simulation training followed by analysis of training sessions, identification of errors, and discussions of emotions and feelings that influenced the trainees can help enhance their learning experience exponentially.

“Written by Siddhi Latey (Weloquent)”

Category: Blog

What can Graduating Nurses Expect while Starting off their Professional Journey?