Today on the Osmosis from Elsevier blog, we explore the realities of becoming a new nurse, including debunking some persistent myths and sharing some helpful tips for what to expect throughout your nursing career. A number of challenges and rewards come with working in the nursing profession. As a nursing student, you likely have some pre-existing beliefs about the field from television, movies, social media, experience in giving or receiving care, or even from well-meaning family members or friends. Let’s demystify some common misconceptions surrounding nursing!
1. My education is complete.
Following graduation, you may ask yourself, “What more could there possibly be to learn?!” Don’t throw your computer and books in the fire just yet. There’s so much more to learn as you begin your first nursing job! The NCLEX-RN® – which is the exam nurses must take to obtain their registered nurse license – is designed to test whether a nursing program graduate is minimally competent to practice nursing safely. However, none of us go through nursing school just to be “minimally competent.” More likely, you want to be excellent and qualified nurses for your patients!
Depending on your facility, there’s typically a formal orientation period of several weeks or even a credentialed nurse residency program. And even after that, your education isn’t done! It usually takes a few years in the same or similar job to move from beginner to competent, and 4-5 years to reach expert level. If you decide to change specialties, like moving from the cardiac ICU to an orthopedic unit, note that you won’t completely start over, but there will be an adjustment period and more learning to look forward to.
2. I won’t have to do the “grunt” work.
You may think that since you’re a registered nurse now, the nurse’s aids and care techs will do all of the bathing, toileting, and patient turning. While this may generally be the case, there are a few things to keep in mind. Nurse’s aids and care techs, sometimes called unlicensed assistive personnel or UAPs, are not always available. Not all units employ UAPs, and sometimes units may be short-staffed. Or there may just be 1-2 UAPs for an entire unit, so, at times, they’ll be busy with other patients when you need them.
Note that in all cases, the nurse is ultimately responsible for patient care, even if some tasks were safely and appropriately delegated to a UAP. Additionally, performing these tasks rather than delegating them provides excellent opportunities to gather valuable information about your patient’s strength, sensation, ability to perform activities of daily living (ADLs), and skin integrity.
3. A three-day workweek is the best.
In many healthcare facilities, full-time nurses only work three days per week for 12-hour shifts, which you may have already experienced if you worked as a nursing assistant during nursing school. This schedule has its perks, but let’s break it down a bit further. If you’re working three days per week for 12-hour shifts, you likely arrive at the unit 15 minutes before your shift starts to receive a handoff report. Additionally, you may have a significant commute, shortening your “off” time. Some days, you’ll need to stay late to complete your charting or wrap up care tasks. Pretty quickly, a 12-hour day can turn into a 14-hour day or longer.
Additionally, keep in mind that 12-hour shifts tend to be mentally and physically exhausting. Once you’re home from work, you’re probably not going to get much done other than eating a quick meal and sleeping, which means the chores of daily life, such as cooking, cleaning, and exercise, will likely need to be done on your non-working days. Last but not least, remember that most businesses are open during a traditional work day or work week (Monday-Friday, 8-5 PM), So if you’re working weekdays, weekends, or nights, it can be difficult to make appointments or even socialize!
So, while a three-day workweek sounds like a dream come true – and it definitely has its benefits – it’s not always as amazing as it may appear to be at first glance.
4. I’ll always work “by the book.”
You may be comfortable being a strict rule follower due to the nature of your nursing clinical hours, but some days, nurses live in a world of gray rather than black and white. Try to resist the feeling of shock and surprise when your clinical situations or patients don’t always follow what your textbook says. For example, your patients may not always react to medication as you expect them to, or they might not always follow recommendations or instructions about diet or smoking cessation.
Also, keep in mind that some of the nurses you work with might not always follow the rules either! For example, if a non-urgent medication was due at noon but your patient just fell asleep after a long sleepless night, it’s likely fine to wait to administer it until they wake up. There may be special circumstances when it’s better to allow family to stay past visiting hours. As you begin your work as a nurse, your clinical judgment will help you decide whether working “by the book” is completely necessary.
5. I have to work for at least a year in Med-Surg.
Your peers, former students, and teachers may recommend that you work in an acute care medical-surgical unit (known as Med-Surg) right after graduation. While Med-Surg is a great setting to learn a variety of skills such as time management, communication, and patient care, it’s likely a dated misconception. In fact, there are so many settings to work in right out of school that you don’t have to plan to work in Med-Surg or even in a hospital at all.
While exploring your career options and interviewing for positions, be sure to ask about the facility’s orientation process. Some hospitals have a new graduate residency program that provides new graduate nurses with training, guidance, and mentorship. Some residency programs even allow new nurses to work on multiple units within the first year to see where they fit best. So, if you’re interested in working in a specific area like pediatrics, community health, or research, you should go for it! After all, it’s totally up to you where you work, and you should choose a job that will make you happy.
6. I’ll only be asked to work my pre-scheduled shifts.
As mentioned earlier, your work schedule could be three shifts per week. However, many healthcare facilities are open 24 hours a day, seven days a week, or offer extended times such as evenings and weekends. Therefore, you may get messages from your manager or administrator asking you to come in early, stay late, or work on your days off. Your co-workers may also ask you to switch shifts. Even though you’re scheduled for a certain number of work hours per week, there are likely many chances to work overtime. And, while the opportunity for overtime is abundant and can be lucrative, make sure to prioritize your mental and physical health and say no when you need to. On the other hand, you may also notice that there are days when your unit has a “low census” or too many nurses and not enough patients, so your manager may ask you to leave early or cancel a future shift.
7. Providers are rude or mean to nurses.
You may have heard horror stories about providers (doctors, nurse practitioners, or PAs) being mean and rude to nurses. (We’re looking at you, Gregory House, MD!) For example, some institutions used to require nurses to stand up and offer their chairs to physicians when they walked onto the unit. The good news is that, in most cases, this is an outdated practice. As healthcare has evolved and progressed, medicine has become a team sport. Providers (doctors, nurse practitioners, PAs, et al.) couldn’t do their jobs without the vital work and support of nurses. Therefore, most providers are thankful and kind to nurses and value their input. Of course, no matter what profession you work in, there will always be some bad eggs. Do your best not to take it personally.
8. Everyone knows exactly what nurses do.
Going into nursing school, you may think that your family members, non-nurse friends, and even patients have a good idea of what nurses do. However, as you progress through school, you may notice some interesting misconceptions about the profession popping up. For example, some patients may be confused about the role of all of the care team members coming in and out of their room; some people think that all nurses do is change diapers or give out pills. Others may have a skewed perception based on television, movies, or social media.
This confusion about roles may also be the case if you go back to school to pursue a master’s degree or doctorate in nursing. Given the many entry points for nurses to enter the workforce (unlicensed assistive personnel, licensed practical nurse, diploma program, associate degree, or bachelor’s degree), those outside of the field may be ignorant of the critical role of a registered nurse. When you have the time and energy, it’s important to educate individuals when you notice they have misconceptions about nursing.
9. I have to be a nursing expert once orientation is over.
As your orientation period comes to an end, you may be anxious and scared of working independently, which is normal and expected. However, it’s important to note that you’re not expected to be a nursing expert. As mentioned earlier, nursing is a team sport, and you certainly can’t and won’t know everything there is to know about nursing after school is done (or even when orientation is over). You’ll learn new things daily, and you’ll need to ask your co-workers and team members to help you along the way (and also be prepared to help them).
Additionally, depending on where you work, you’ll have a policy and procedural manual to outline the steps you should take to perform certain skills that you’re unfamiliar with. At the end of the day, it’s better for patient safety for you to ask a question about something you don’t know rather than assume and make a mistake. Even if it doesn’t always seem so, every nurse has been in your shoes before and knows what it’s like to be brand new.
10. I have to write a formal care plan for every patient.
One large part of clinical paperwork in school is writing up formal care plans, so you might wonder, “Where do care plans fit into my nursing workday?” Although the experience of care planning will inform your patient care, you likely won’t be expected to create formal written care plans for each patient every day. More commonly, you’ll incorporate some care planning aspects while documenting in the electronic health record (EHR), but it may look very different than your clinical paperwork. Despite that, the skills you obtained from writing care plans (e.g., prioritization, organization, evaluation) will make you a better nurse and benefit you in the long run.
Conclusion
Take note that the path to nursing is different for everyone, and each experience is unique. Some of these misconceptions may apply to you, and some may not, which is okay! Here at Osmosis from Elsevier, we’re excited to help you navigate the path from nursing school to your nursing career. Contact us at [email protected] with any questions or recommendations for ways our study tool can better fit your study needs. We’re here to help!
Authors
Paige Randall, MS, RN, CEN, CNE, Script Writer and Editor at Osmosis from Elsevier, has been a Registered Nurse for ten years with a clinical background in cardiac, emergency nursing, and nursing education. Paige is currently working on her PhD in nursing at Duke University. At Osmosis from Elsevier, Paige works as a scriptwriter and editor. She lives in Raleigh, NC, with her husband and their dog, Bocelli.
Elizabeth Lucas, EdD, RN, CNE, Senior Content Manager at Osmosis from Elsevier, has been a Registered Nurse since 2008. She received an Ed.D. with Emphasis in Nursing and Health Professions Education program from Bryan College of Health Sciences, an MSN in Nursing Education from Drexel University, and a BSN from Duquesne University. Liz’s clinical background is in oncology and includes time spent working in a Medical Oncology Unit, a Critical Care Bone Marrow Transplant Unit, and a Hematology/Oncology Clinic. Liz has experience writing questions for the Oncology Nursing Society, which helped her discover a love for nursing education and assessment. Later, Liz transitioned into nursing academia, where she taught in a pre-licensure nursing program for several years. Liz feels passionate about building a strong nursing workforce through increasing education accessibility and believes in the role of technology in that pursuit. At Osmosis from Elsevier, Liz manages the nursing assessment and scripting teams. Liz currently lives near Baltimore, MD, with her husband, two sons, and dog, and is an avid Pittsburgh Steelers fan. Liz loves spending time with her family and friends, especially at the beach and around the fire pit, roasting marshmallows.
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