EDUCATION
June 30, 2022

5 Vital Skills You Didn't Learn in Nursing School

5 Vital Skills You Didn't Learn in Nursing School

Being a nurse is hard! Being a new nurse is even harder.

There are countless things that new nurses are not taught in nursing school which is why we’ve gathered some of the top questions that new nurses may have to make the transition from student nurse to graduate nurse a little bit easier.

What Real Nurses Had to Say About Being a New Nurse

Nurse.org asked some new graduate nurses to try and explain what it really feels like to be a new nurse.

Working at the Bedside is a Different Beast

“I thought I would be OK. My nursing program did a good job of preparing us. The clinical instructors presented us with real world experiences and a lot of hands-on experiences. But working at the bedside is a different beast. Our unit is short-staffed every single day. There are very few techs or 1:1s.”

Mentorship Programs Can Make for a Smoother Transition

“Truthfully, I was so scared to start at the bedside. I heard horror stories from my classmates and friends that had already graduated. I got really lucky by getting a job at a large children’s hospital with a mentorship program. I feel like it will give me insight by pairing me with a more senior nurse. Hopefully, that will help the transition and make things smoother for the future.”

Nursing is Very Different From Nursing School

“Being a graduate nurse is not entirely what I expected. Everything in nursing school is presented in this pretty picture. Then you start clinicals. The problem is – by the time you start clinicals it is often too late to switch majors. I love helping the patients and the medicine aspect. I just am not sure why being a new nurse is so difficult when I do love what I do.”

The Top 5 Skills That New Nurses Need to Know But Weren’t Taught in Nursing School

If you ask any new nurse there are a million things they wish they were taught in nursing school. Sometimes the non-clinical, non-nursing, non-medical stuff is what really can make or break a shift. The top things identified that new nurses wish they knew are,

  • Communication
  • Delegation
  • Career Navigation
  • Conflict Management 

1. Communication

This is essential for not only new nurses but also seasoned nurses. Good communication means entering each interaction with patients, coworkers and management with the intention of understanding, listening, and addressing concerns, questions, and opinions.

Knowing when and how to say no can be difficult especially because nursing is a customer service industry. It’s important to discuss with your patients the plans for the shift as well as expectations, goals, and any events that might be happening.

Some top tips for effective, meaningful communication include,

  • Avoid using “sweetie”, “honey” or other nicknames for your patients. Ask your patient what they would like to be called at the start of your shift and use that name to address your patient.
  • Speak clearly and simply. Do not use complex medical terms that your patient might not understand.
  • Maintain eye contact with your patient when having a conversation.
  • Sit at your patient’s level if possible. If the patient is sitting, pull up a chair and sit next to them. Try not to talk down to them.
  • Provide words of encouragement when actively listening to your patient.
  • Acknowledge that you are listening by using phrases such as “okay”, “I see”.
  • Ask them how you can help at the start of your shift and before leaving the room.
  • Use teach-back when talking to the patient.

2. Delegation

Assigning takes to others can be very difficult, especially to someone that is more senior than you or older than you in age. 
However, as a nurse, it is important to designate appropriate tasks to a CNA, LPN, or even a nursing student. 

First, it’s important to understand the scope of practice for these positions and what skill sets the individuals have. You do not want to delegate something to another healthcare provider if they are unable to accomplish the task.

There are five rights to delegation:

  • Right task
  • Right circumstance
  • Right person
  • Right supervision
  • Right direction and communication

Proper and appropriate delegation facilitates quality care. Improper delegation can lead to poor patient outcomes, missed patient care, and even legal issues. Knowing how to properly delegate is important and takes practice.

3. Job Contract Navigation

Nursing offers a lot of flexibility and there are countless paths you can take as a new nurse.

Sometimes you land the ideal nursing job as a new grad. One application, one job and you’re done. Others will have to settle for another specialty, maybe another hospital system entirely.

It can be frustrating but know that you can always change. There are a few things to keep in mind when getting ready to sign your first nursing contract. Look at,

  • Salary
  • Bonuses Payments
  • Vacation Days
  • Insurance Benefits
  • Scheduling
  • Non-compete clause
  • Orientation

Be Wary of Bonuses

Some hospitals are offering LARGE bonuses to nurses. But, there is usually a catch. 

Some will break the bonus up into several payments over the course of 12 to 18 months. The longer you are employed at the hospital – the more money you get. Some contracts might even mention that if you leave before the end of the probationary period you will have to pay back all the bonus money.

A contract is binding so if you want 10 vacation days a year and the contract only states that you will get 8, then this must be negotiated ahead of time. Once a contract is signed, it is very difficult to make changes.

Look Out for Non-Compete Clauses

Another red flag to look for is a non-compete clause. It is rare that you will see this in a nursing contract but it is possible. Essentially, this means if you leave Hospital X you can not work at Hospital Y for a specific amount of time. This more likely will be seen in private practice offices.

Take Note of Your Benefits

Most healthcare systems will offer health benefits to full-time and part-time employees. This doesn’t always include dental and vision insurance. This might be something to consider if you wear glasses or have a child that needs braces. You can ask to see health benefits prior to signing a contract in order to fully understand your coverage and deductibles.

You May be Able to Negotiate

Most new nurses do not think they are able to negotiate their contract. In fact, even experienced nurses don’t think they can negotiate.

While some hospitals will not negotiate and that is firm but some things can be discussed. It can be confusing how to start the conversation but if you do not ask then you will never know. If you decide to negotiate, it’s recommended to request a meeting over the phone for a direct conversation versus email. Some prefer email communication because then there is a paper trail.

When negotiating, research the average pay rates for your specialty but also based on geography and seniority. For example, if you are accepting a job in Maryland, do not try to negotiate with a pay rate for a nurse’s salary in California.

4. Quitting Your Job

If you decide that your job is just not a good fit then resigning might be your only option. If you plan on resigning from your position, make sure that you know much notice you are required to give. 
Some hospitals require 2 weeks while others require 4. It is best to have a conversation with your HR department and your nurse manager. 

Write a letter indicating that you are resigning and why. You are not required to say why but if you feel comfortable sharing you can. The most important thing is to keep the letter professional so that you can be rehired by the hospital in the future.

5. Conflict Management

People don’t like conflict. But conflict is part of the job. Conflict with patients. Conflict with coworkers. Conflict is a reality. Knowing how to handle conflict takes skill, experience, and patience. It can be scary dealing with workplace conflict, especially as a brand new nurse, but with the proper tools you will be able to conquer this skill in no time.

Conflict resolution is how strong nurses and leaders are made. Because communication is a large part of the nursing profession, conflict is readily found throughout shifts. Reducing workplace conflict helps keep patients safe, boosts morale, and increases shift efficiency.

What Is it Like Being a New Graduate Nurse?

It can be daunting to start your first job as a new nurse. Orientation provides a buffer but it is short-lived.

There are a lot of emotions you might feel as a new nurse: overwhelmed, excited, scared, nervous, unsure, and even confident. Although most will say confidence is a wavering feeling. Some days are better than others.

New nurses have to navigate countless pathways during their first few years at the bedside. By trying to lean into the profession, learn from more experienced nurses and understand interpersonal relationships you can succeed. 

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