What to Expect On Your First Day as an RN

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.

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.

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.

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.

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.

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.