What to Expect On Your First Day as an RN
Nursing school graduates are often nervous on their first day on the job. This guide outlines what changes to expect when joining the workforce and offers survival tips for your first day.
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I remember my first day as a nurse. Years of working as a nurse's aide, hours of clinicals, return demonstrations, and classwork didn't prepare me as well as I'd hoped for the anxiety and multitude of questions on my first day.
Nursing orientation lasted nearly a week at the large Chicago children's hospital. It was almost like being back in the classroom again, except my first day in the pediatric neurosurgical unit loomed at the end of the week. Butterflies don't begin to describe those feelings.
It turns out I wasn't alone. Each of the new graduates in the orientation class felt the same way, as did every fresh graduate I oriented in the coming years. So, how can you make your first day better than mine? Preparation. You might think that our education and clinical hours were enough preparation for your first day working as a nurse, but you would be wrong.
Clinicals and return demonstrations happen in a structured environment under careful supervision. As a new graduate nurse, you work independently in an unfamiliar environment to care for your patients.
In this guide, you'll discover what you need to know about your first day working as a nurse and the type of preparation that can help lower your anxiety level.
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Your First Day as a New Registered Nurse
While your first week as a new registered nurse may differ slightly based on the hospital where you work, generally, your experience will parallel other new graduates across the country.
The coming days may be filled with anticipation and anxiety, but with a little preparation, you can begin your career confidently and set expectations appropriately.
You'll receive a letter or an email from the human resources department before your first day of orientation. The hospital outlines what to expect in the coming weeks, including whether they provide lunch on the first day and how to dress for classroom orientation.
At orientation, you may sit in a classroom with new nurses who have a temporary license or have passed the NCLEX-RN to become an RN. Classroom time can vary from a few days to a few weeks, depending on the unit. Nurses on a general medical-surgical floor may experience the shortest classroom nursing orientation, while those in a specialized or intensive care unit may spend a few weeks in the classroom.
Your nursing orientation includes instruction on the electronic medical record (EMR) system the hospital uses and how to enter information. Most hospitals spend several hours reviewing the medical record process and allow you to practice on a computer so you are familiar when you reach the unit.
You also receive an orientation on the general hardware used throughout the hospital, such as IV pumps, patient monitors, and oxygen delivery equipment. Having a basic understanding of how the hospital software and hardware work helps reduce the potential for medical and charting errors in your first weeks.
Many hospitals find it challenging to recruit and hire nurses experienced in the emergency or operating room. To address this need, some hospitals have started residency programs for new graduate nurses. The program includes general hospital orientation, extensive classroom work, and nursing orientation on the unit for roughly one year.
After classroom orientation, you match with a preceptor on the unit. This is the nurse responsible for orienting you to the structure of the unit, showing you where to find supplies, and explaining the process the unit uses in patient care.
New nurses can expect to shadow their preceptor for a couple of days before taking their own patient assignment. In the first week, you and your preceptor usually split one patient assignment so they have time to help when you have questions. This gives you a lighter load as you learn to navigate the unit and learn the EMR.
Your First Day of Nursing Orientation
When you arrive at the hospital, someone will direct you to the conference room where your first day of orientation will take place. In some hospitals, you'll be in orientation with all staff. In others, you may do orientation with just nursing staff.
Human resources representatives often lead the first several hours of orientation. You begin by filling out a W-4 form so your employer withholds the right amount of taxes for the IRS. You must also provide several forms of identification to complete an I-9 form. This proves you are eligible to work in the United States. There are several documents that can establish your identity and authorization to work.
The remaining time in the morning may be used to learn about the different medical insurance options the hospital offers and for filling out forms for life and disability insurance. Most hospitals have a 30-90 day waiting period until you are eligible for medical insurance. This gives you ample time to take the documentation home and select the plan that works best for your situation.
How Does Working as an RN Compare to Clinicals?
There are definite differences between working as an RN or being a nursing student performing clinicals. You may notice more differences as you begin practicing as a nurse, including the following.
You may have some new job anxiety over care plans. You'll likely remember the lengthy papers evaluated by your clinical nurse instructor. The night before a clinical, you gathered all the information about your patient, including diagnosis, lab work, medications, and pertinent medical history.
Then you may have spent up to four hours writing a detailed care plan with assessments, diagnoses, interventions, and the reasons you choose these diagnoses. Once turned in to your clinical instructor, you may be asked to justify your choices.
However, as a nurse, these intricate and highly researched care plans are a thing of the past. A patient's status can change quickly, and so must the care plan. Many hospitals use care plans that have checkboxes, with additional space for writing specifics. The days of spending hours on a care plan for a single patient are long gone.
While the care plans you write in school are not practical as a staff nurse, they do prepare you for the critical thinking and decision-making necessary to provide quality nursing care.
In 2018, well before the pandemic, an online poll of 4,619 people in the U.K. found that 74% of those polled were overwhelmed or unable to cope with stress. Stress and anxiety are part of the modern human condition, and it rose substantially during 2020 and 2021.
While nursing students are subject to pressure, the stress you experience as a nursing student differs from the stress you experience as a staff nurse.
Both experiences are taxing in their own way. While in school, nursing students fret over passing exams, keeping track of assignments, and ensuring they don't fail out of the program. In clinicals, your instructor and staff preceptors oversee your patient care. They must check and double-check your movements and actions.
As a staff nurse, you lose the stress of classwork and testing and take on the pressure of holding your patients' lives in your hands. It's vital you keep track of your patients' medical care, medication, procedures, wound care, labs, and a multitude of other processes. This happens while you juggle phone calls to the doctor, call lights, and patient care.
When you entered nursing school, you learned some new medical terms. For example, a heart attack is a myocardial infarction often caused by a coronary thrombosis (clot). An irregular heartbeat is an arrhythmia and an unknown cause is idiopathic. You may have memorized these terms in school, but once you're a staff nurse, the vocabulary list grows.
As a nursing student, I spent hours looking through a physician's desk reference (PDR) for the name of a medication. At that time, there was no internet, just massive reference books we lugged around. The book has now been digitized and is called the Prescriber's Digital Reference, which you can access on your smartphone--definitely easier to carry with you!
The name of the medication that nearly every elderly patient on this medical-surgical unit was taking was called MOM, a common medication. The nurses and instructors wouldn't tell the students the name of the medication, only the acronym, and that acronym wasn't in the PDR. It was a prank that the seasoned nurses played on the student nurses. No one could find this medication in any reference book, and most student nurses would not call the pharmacy to ask.
It was milk of magnesia! The staff nurses enjoyed the prank--and I did too when we had student nurses come through in the following years.
You might also find that the floor nurses abbreviate incentive spirometry as "IS," BMP for basic metabolic panel, or "tropes" for troponin, a chemical commonly elevated after heart injury.
It can take a couple of months to understand all the abbreviations the staff nurses use to communicate. This should not concern you. In fact, your colleagues expect you to ask questions. They remember what it was like to be a new nurse, and you'll remember too in a few years when you're orienting a new nurse.
Have you graduated and passed the NCLEX-RN? Then your long-term focus on homework and testing is finished. You must read to keep up with the new medical treatments and medications, but you no longer have to take tests.
Initially, it may feel good to rest and relax, focussing solely on getting through the day. In the coming months or years, you may want to take a new certification examination or advance your education. For the moment, take a breath and relax; homework is done.
Broad school, narrow practice
Nursing school teaches you a little about a lot of subjects. You learn about mother/baby care, obstetrics, medical/surgical, ICU, kidney dialysis, oncology, and orthopedics, to name a few medical markets. However, when working, you narrow your focus.
For example, you may forget most of what you learned about obstetrics or orthopedics if you've started working on a pediatric neurosurgery unit at a children's hospital. You won't need to remember the intricacies of the stages of labor or the small bones in the ankle. Instead, you focus on hydrocephalus, internal and external shunts, brain tumors, and seizures. In other words, you move from a broad perspective on medical and nursing care to a more focused perspective.
Updated evidence-based protocols
You may find that hospitals also strive to use the most updated evidence-based protocols when caring for their patients. When you were in school, you learned the complexities of how to do a wet-to-dry dressing change or the way to hang chemotherapy.
However, after graduation, you will find that wet-to-dry dressings are almost never used since new wound management products have improved wound healing, and your hospital has a chemotherapy nurse who hangs all the medication. Nursing care changes with the development of new procedures.
Professional values and attitude
One published study from BMC Medical Education looked at the professional values of a student nurse and compared those against a staff nurse. More than 250 nurses and 100 students took the survey.
Researchers found that nursing students' perspectives toward professional values were important, and those focused on caring and justice were low in staff nurses and student nurses. This indicated to the researchers that hospitals needed to spend more time and energy on values training after nurses start working.
A second study evaluated the scores of 313 nurses and 81 nursing students. The researchers found that 72.6% of the nurses and 65.4% of the students had a positive attitude toward nursing, and the remaining had a neutral or negative attitude.
A nurse's attitude has a significant effect on burnout. This indicates it is necessary to further study and develop interventions that help to improve the attitude of nurses.
Tips for Surviving Your First Day as a Registered Nurse
Knowing what's coming on your first day as an RN helps to calm the nerves. As you settle into your new job, here are a few practical suggestions to help you prepare for the work ahead.
1. Bring the essentials: Nothing feels worse than knowing you don't appear prepared for your new colleagues and boss. Be sure to bring plenty of pens, as you will likely have staff who ask to borrow one and never return it.
Most nurses wear their stethoscope around their neck. However, it can get in the way when transferring patients, making beds, or changing dressings. Consider purchasing a stethoscope holster.
You also want to carry some money in your pocket if you don't have time to get to your locker for cash or get off the unit for lunch.
2. Seek out a mentor: Most hospitals assign a new graduate nurse a preceptor. This is a seasoned nurse who can show you the ropes and answer your questions. However, not all matches are made in heaven.
You will also want to seek out a mentor who can help guide your career development and advancement. Take your time and put a lot of thought into the person you go to for career questions.
3. Remember new names: This has always been a problem for me. On your first day, you'll be introduced to nurses, support staff, doctors, and your patients. That's a lot of names to learn quickly. Remembering a person's name and how you use it can have a profound effect on their impression of you.
The first time you meet someone, try to use their name two or three times in conversation. This helps to imprint their name on your brain. Focus on the person you are talking to and not what you plan to say next. Also, try to link the name with something you already know. For example, I recently met a woman named Mary Moore. Immediately I thought of the actress Mary Tyler Moore, and it was easy to remember her name from then on. At the end of the day, go back over the names of the people you met that day.
4. Ask questions—it's expected: Your colleagues expect you to ask questions, so don't disappoint them. The best way you can learn how to do things is to ask questions and shadow another nurse.
5. How to deal with stress: You will deal with stress throughout your work and personal life, so explore stress-reducing strategies. Consider trying exercise, yoga, meditation, improved nutrition, reducing your caffeine intake, laughter, and spending time with friends and family.
6. How to adjust to changing shifts: Most nurses swing between first, second, and third shifts. When you slowly adjust your sleep schedule for two or three days before your shift starts, you'll have fewer problems with performance and sleep schedule. You adjust more easily when you continue to exercise, stay hydrated, and lower your intake of caffeine and alcohol.
Remember: You Deserve to Be Here
The public holds nurses in high esteem. They are trusted medical professionals who work each day to save and protect the lives of their patients. Some nursing graduates start their careers feeling a little like a fraud. This is called imposter syndrome. The feelings are fairly common, occurring in roughly 30% of high-achieving individuals.
Feelings of self-doubt when facing new challenges are normal. But with imposter syndrome, you may experience an encompassing fear that you don't have what it takes. The syndrome was first diagnosed in women in the 1970s, but men are also susceptible. The syndrome is closely related to perfectionism, a common trait found in nurses whose work demands perfection.
When you feel pressure to perform at your best all the time, it can lead to feelings of incompetence and anxiety. However, there is no single answer why some people experience imposter syndrome and others do not. Factors that influence the development of the symptoms include your personality, childhood experiences, and environment.
Acknowledge these feelings and put them in perspective. Remember why you became a nurse and that your clinical instructors, professors, and preceptors have recognized your abilities. Remember that others who have evaluated your skills believe you have the right to work alongside more experienced nurses and care for critically ill patients.
Your willingness to ask questions and acknowledge when you don't have the answers is as important as knowing how to care for your patients. No one expects you to know everything right out of school. Therefore, take this time during orientation and throughout your first year as a new nurse to absorb as much information as possible from the seasoned nurses who work alongside you.
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