When you come to work for your first day as a new hire, new graduate RN you’ll probably feel a lot like a nursing student again. You’ll follow your preceptor around as they give you the lay of the land, you’ll take vital signs and refill some water pitchers, and most of what you hear in handoff report will go over your head. You’ll also meet a bunch of new colleagues and coworkers- which comes with the internal debate of whether or not to shake hands in a hospital (just smile and wave hello; I learned that the awkward way).As the first few days blend into weeks, you’ll start to understand more of what you’re hearing in handoff. So much so that you’ll soon identify risk factors and concerns, follow up with focused assessments, and interpret vital signs (rather than just take them). You’ll start to understand lab results, establish rapport with your patients and advocate for their physical and emotional needs. This includes making your first phone call to a doctor, which I can assure you will be just as awkward as every nurse’s first time calling a doctor. Then before you know it you’ll be off orientation and taking your own assignments.The thing that you won’t immediately recognize in your first few months as a new grad is the state of stagnancy that most of the nurses you met on your first day have accepted. This is not to offend anyone; when you’ve been a nurse for many years, and you’re a good one, it can be hard to change your practice or the unit. Those who do pursue change either climb the ladder within the unit (from bedside to charge nurse and some even unit educators or managers) or they move onto to graduate school (Clinical Nurse Specialists, Nurse Practitioners, etc). But most of the senior nurses that you meet on your unit, especially if your unit doesn’t have a high turnover rate, are happy to spend years just focusing on their patient assignments and clocking out. Some nurses don’t have the desire to work more than they need to on process improvement projects or updating a policy. This can be for a variety of different reasons such as family, outside interests and sometimes even burn out. And for many, it can simply be because they don’t see the need for change “Why fix it if it ain’t broke”, right?The thing about healthcare, like many aspects of our lives, is that there is always room for improvement. This is the foundation of research and evidence based practice. And chances are that you, as a new graduate nurse, are better at this than most senior nurses. You’ve done research more recently, you’ve done presentations and projects with the latest data, and your practice isn’t clinging onto outdated recommendations. This gives you an advantage that is unique to new graduate nurses. And once you pass the shy self-doubt phase that every new grad goes through, I hope you turn this advantage into a contribution.When I was hired as a new graduate nurse at Lucile Packard Children’s Hospital at Stanford, completing a group EBP project was part of my program. Initially when I heard the dreaded term “PICO question” I threw my head back and groaned. I was a week into orientation, filling water pitchers and taking vital signs, and rewriting a PICO question a million times as if I was a nursing student again. However, the difference this time was that after my new grad colleagues and I committed to a topic, we were actually able to implement our intervention onto the unit. We collected data before and after implementation, we analyzed the impact the intervention had on patient outcomes and the results led to a sustained practice change.Fast forward several years and now I have the pleasure of being a co-coordinator in the Nurse Residency Program at LPCH, specifically for the new graduate nurses hired onto Maternity. After each hiring cycle, I meet new graduate nurses on their first day of onboarding, lecture them throughout their 12 weeks of didactic courses, check in on their progress throughout orientation, and lovingly criticize their PICO questions when the time comes. And just as much as I inspire them with my nursing practice and experience, they inspire me with their passion and fresh ideas.After years of juggling bedside along with my other pursuits (I also became an IBCLC and a reproductive health clinical instructor at my nursing alma mater) I understand first-hand how quickly burn out can happen. Metaphorically speaking I have moments where I’m actively paddling my kayak and others when I just want to float down the river. Just when I think I don’t want to do more than simply clock in and out of my shift, I meet a group of new grads and hear their new ideas. I remember why I became a nurse and how excited I was to enter healthcare.You will learn an exponential amount in your first few years of nursing. In addition to learning assessments, interventions, policies, unit culture, and calling a doctor- you will also learn about yourself and the kind of nurse you want to be. You will have the option to accept stagnancy or promote change. You will have the opportunity to teach not only your patients and their families but your colleagues as well. In between the chaos of applying, interviewing, refreshing your email 100x/day, and waiting for that dream position- don’t lose sight of everything that you have to offer. New graduate nurses bring new perspectives, and that’s exactly what healthcare needs.Author – Jessica Dyatlov BSN, RN, IBCLC
