After I graduated from nursing, I began my first job in a specialized nursing unit — labor and delivery. I was delighted because who gets hired to their dream job on the first application?
It wasn’t quite as easy as it sounds. I’d worked hard during my second-to-last practicum to prove that I could handle a full patient load; so I could work my final placement helping laboring moms deliver their babies. The nurse manager offered me a full-time position on my last day.
I enjoyed my first job, but there were many things I wish I had known then that I know now.
Essential Skills I Wish I’d Had
In our current world of severe nursing shortages, new graduates are sometimes offered nursing positions in emergency rooms (ERs) and intensive care units (ICUs). Several years ago, they would have required at least two years of medical-surgical nursing. Not anymore.
Newly graduated nurses are a knowledgeable and enthusiastic bunch. However, some of their skills have only been practiced in labs and not on patients. I was no different. I was oblivious to the essential skills I needed for my first nursing position. I did not understand the need for an experienced nursing team in a critical care area. Here are some of the essential skills I wish I'd had:
- Critical Thinking
Critical thinking is the ability to determine the right course of action based on your ability to receive and synthesize information — learned through observation, experience, and knowledge. As a new grad, I lacked the medical-surgical job that would have consolidated my skills before graduating to a higher level of difficulty. Book knowledge could not provide the hands-on experience of watching for subtle signs of pre-eclampsia and delivering a baby when the physician arrived late. You cannot rush the development of critical thinking; it is achieved through experience and takes patience, time, and hard work. What I found helpful was paying close attention to my preceptor, carefully observing the more experienced Nurses in the unit every change I got, and asking a lot of questions to help me understand the rationale behind decisions that were being made.
- Asking for Help
I knew I needed to develop the decisive and strong skills needed for a critical care area. Things can go wrong quickly during labor and delivery of a child. I remember being scared to ask another nurse for help because I thought they would judge me as a new grad. I needed to overcome that fear and learn to get comfortable asking for help to be a safe nurse.
To communicate is to listen and speak clearly in a manner that promotes listener understanding. Good communication reduces conflict and errors and fosters good relationships. Although I interacted well with laboring moms, the interpersonal communication between myself and my colleagues was strained. They were not used to having an inexperienced new graduate nurse in such a complex care area. This made for uncomfortable situations for them and for me. They had to figure out what they could count on me for and what I still needed to learn and in the midst of a busy shift that can be challenging. I learned that clear and honest communication served us both the best. I understand that now, but I wish that their discomfort with my inexperience had been addressed before I accepted the position.
What I Would Insist On Now
As a now-experienced nurse with extensive critical care experience, I would advise all new graduates to get some experience in a medical-surgical area before choosing a specialized field to work in. However, if you were hired to a specialty area as I was, you have to work harder to accelerate, strengthen and solidify your skills.
A few years later, I had a Ground Hog Day experience. I got another chance to restart my first job. How did I do that? After moving overseas for several years, then staying home for a few more to raise children, I took a refresher course and returned to nursing. Although not a new grad, I was inexperienced and once more a newbie to the nursing profession. I accepted a job in another specialty area – pediatrics. Here are four things that I would insist on now if I could do it over again:
When I arrived at my new position in pediatrics, I was given an orientation to the nursing unit and the facility. Orientation let me find the staff parking lot, get a locker, discover the location of the crash cart, clean and dirty utility rooms, and learn policies. Orientation provides the time and opportunity for nursing graduates, nurses returning to the profession or changing specialties to cement their skills while not carrying a full patient assignment. Orientation helps nurses get familiar with their new setting and develop confidence in themselves and their skills.
- Regular performance evaluations. While most organizations do annual performance evaluations, I never once received one while working in labor and delivery. Performance evaluations are an essential component to becoming a confident and experienced nurse. They provide the opportunity to get feedback on what you are doing well and design a plan to help you with areas to work on. They are also an opportunity to discuss interests and plan career advancement.
- Mentorship. I was assigned a mentor in pediatrics on my first shift. This nurse patiently taught me the computer system and helped me solidify my nursing skills by asking the other nurses to alert us to any intravenous insertions and complicated dressing changes. She helped me with my organizational skills and introduced me to the other staff. Her mentorship smoothed my entry into the nursing unit and gave me one person I could count on if I encountered a problem. There is nothing more helpful in starting out something new that a mentor or preceptor who invests in you.
- Get a career coach. I wish I had known more about the 33 nursing career opportunities for nurses. Your first job can be a stepping stone to becoming a psych nurse, a certified registered nurse anesthetist, or a public health nurse. To achieve these nursing positions, you must be focused and disciplined in acquiring the necessary skills, certifications and in some cases advanced education.
My Advice to You
First, I would like to welcome you to the nursing profession. I commend you for undertaking a challenging but rewarding career.
I wish I could do that first job over again and be the confident nurse I am now. However, since I cannot, I will do the next best thing; share my advice. Take a job that fits your new graduate skillset. Remember to work on your critical thinking, leadership, and communication skills. I highly recommend choosing a medical-surgical position even if you receive a prestigious job offer to an ICU or ER. However, if you find yourself working in a specialty area, be ready to take on accelerated learning, take every opportunity to observe others in care situations or procedures and always, always ask for help when you aren’t sure of something.
During your interview, ask for the healthcare organization’s policies on orientation, employee evaluations, and mentorship. If they are not offered, you might want to consider choosing a different job where you will be better supported.
I am passing the baton to you, along with the many things I wish I knew before starting my first job.
Lalithabai, D. S., Ammar, W. M., Alghamdi, K. S., & Aboshaiqah, A. E. (2021). Using action research to evaluate a nursing orientation program in a multicultural acute healthcare setting. International Journal of Nursing Sciences, 8(2), 181–189.
Miller, J. (2019). 12 Nurses Share Their Favorite Mentoring Advice. American Association of Critical Care Nurses.
Nurse Journal. The 35 Best Specialty Career Choices for Nurses
Bio: Alice Blackmore, MN, RN
Alice Blackmore is a freelance writer, registered nurse, and owner of Insightfulnursing.com. She has expertise in pediatrics, maternal health, critical care, and long-term care. She now shares her years of experience through writing.