As a nursing student, you undeniably learn a lot in nursing school. By the time you graduate, you'll be an expert on the human body and well-prepared for all of those procedures that may have scared you at the beginning of your studies, like drawing blood and giving shots. With that in mind, you can't possibly know everything about nursing until you actually land a job -- and that's okay. Chances are you will continue learning throughout your entire career. In this article, experts share advice on what nurses learn on the job, rather than in the classroom.
1. Time management looks different when you're employed.
Managing your time among a million responsibilities is difficult in nursing school. You might feel surprised when you show up to your first day on the job and realize that you need to entirely reevaluate your time management skills.
This is partially thanks to long nursing shifts, according to Dr. George Zangaro, dean for Walden University’s School of Nursing.
"I was not prepared to be at work for 14 hours, but the reality was that until I learned how to organize my day, prioritize my tasks and chart efficiently, I was going to have some long days," Zangaro said.
It also means you need to advocate for yourself to get the breaks you need to do your job effectively.
"Things get busy, you need to speak up to make sure you get adequate time away from the floor," said Emma Leigh Geiser, who works as a registered nurse (RN), blogger, freelance writer, and financial coach.
2. You're likely to take on a lot of responsibility very quickly.
Showing up to work on your first day can be nerve-wracking. You might feel like you will never get the hang of it. So it might come as a small shock to learn how quickly you'll go from being the newbie to the veteran.
"In less than six months, you might be acting as a charge nurse," Geiser said. "Things happen fast and, before you know it, you may be the most experienced nurse on shift.
This can certainly feel intimidating, especially if you feel like you're constantly learning new aspects about your job. That's why it's important to know who your resources are so you know who to call for help," Geiser added.
3. Charting is just as important as your hands-on responsibilities.
You might feel nervous about giving shots or starting IVs, and understandably so. But one responsibility that you might unexpectedly feel pressure to get right: filling out charts. Nurses use charts to record very important medical and legal notes, along with information about insurance payments, accreditations, and case studies.
"The chart is a legal record," said James Cobb, an RN and Army veteran who has been an emergency department nurse since 2004. "Dressings change. The effects of medications wear off. Memories fade. What remains is what you wrote in the chart."
Plus, Cobb added, charting responsibilities for nurses have only increased over time.
4. You won't remember everything you learned in school.
The majority of your patients will come in with one of the 10 most common conditions or illnesses, according to Cobb. Working with these patients will feel like second nature over time. But those other illnesses that you study in nursing school will be important too, even if they do appear infrequently.
"When you do have a patient with one of the more rare conditions you've learned about in school, it usually won't look quite like what they told you," Cobb said.
In those cases, Cobb added, you may have to hit the books again: "Then, because you haven't thought about the rare condition in quite some time because you hardly ever see it, you're going to have to look it up."
5. Patients' families need care too.
It's always challenging for healthcare workers when a patient is on the verge of death or has just passed away. But nursing is not just about dealing with the sick -- it's also about relaying difficult information about terminal illnesses to patients' families.
"There is an expectation that everyone knows how to deal with a dying patient or how to comfort a dying patient's family," Zangaro said. "That is not true, and as a new nurse, I was shocked and scared when I was faced with a situation where the patient was terminal, and the family needed more care than the patient."
6. Your shift becomes your family.
Long shifts mean that you'll have to spend a significant amount of time with your coworkers. The intense nature of working in a healthcare setting will probably help to create a strong bond.
"The nurses that you work with become your work family, supporting you through stressors in both your work and personal life," said Tori Hamilton, who works as an obstetrical RN, international board-certified lactation consultant, NCLEX test item writer, and founder of Mothericity.com
Working on the night shift can be especially conducive to this type of coworker bonding.
"Starting on night shift is the best thing that ever happened to me," Geiser said. "A certain camaraderie was able to form between the physicians, nurses, and night support staff that isn't as evident on day shift. It's a cozy, supportive family on nights."
7. Your salary is not all yours.
You might be jumping for joy when you see your annual salary on paper, and especially when you see that first direct deposit hit your bank account. But beware: The number on your employment contract is not the number that you will actually see.
"Your new salary looks pretty nice until those student loans come up for repayment," Geiser said.
In addition to student loan debt, you'll have to pay bills, rent or your mortgage, car payments, and any other recurring expenses.
Therefore, Geiser said, it's important to approach your finances cautiously, planning out a budget before you even start working. "'Lifestyle creep can have a sudden onset, and then six months later, you aren't sure how you'll ever pay those loans."
8. Working with veteran nurses isn't always easy...
Healthcare is a high-pressure environment. After all, unlike other professions, healthcare workers actually deal with life and death every day. That leaves little room for coddling from your higher-ups and nursing elders.
"One of the most upsetting and frightening parts of being a new nurse is running into an experienced nurse who just doesn't have the patience or time to deal with a new nurse," Zangaro said. "I had experiences in which I was yelled at and told that I was not prepared to practice, and these occurrences often discouraged me from asking for help."
The same is true for working with doctors. "It's difficult to decide when to question orders from a physician, and it can also be challenging to figure out the best approach for doing so professionally," Zangaro added.
9. ...but you will learn a lot.
Despite the sometimes short attitude you might find with the nursing old-timers, you can learn from them.
"Many nurses fresh out of school may enter the workplace with knowledge of different or new procedures that vary from those used by a nurse who has been in the field for a long time," Zangaro said.
Of course, that doesn't always mean that the veterans are right. You'll also need to learn how to navigate working with nurses who are not interested in changing their practices.
"Those more experienced nurses may view a new nurse as being noncompliant if they approach a task in a different or unfamiliar way," Zangaro added. "We are not taught in nursing school how to approach these types of situations."
10. You will (almost definitely) find a job.
If you're nearing graduation but haven't yet locked down a job, do not panic.
"The opportunities are endless," Hamilton said. "I have had the opportunity to work at a nursing home, in obstetrics, being a clinical instructor, a subject matter expert for a nursing app, an NCLEX test item writer, manager, and business owner."
Plus, the Bureau of Labor Statistics projects that the RN profession may grow by 12% from 2018-2028, which is much faster than the average for all professions, and a good reason to keep your head up. When you consider all of the different fields for advanced practice nurses, the future looks especially bright.
"When I first started, I knew about special procedure areas and the different nursing units, but I had no idea nurses worked in informatics, aesthetics, and clinical documentation integrity," Geiser said. "Our career field is amazing!"