Nursing New Grad – Now What…?

-by David Hechim, SN

What kind of nurses will we be? The first answer, of course is “a good one!” But, where? Maybe not so easy to answer. Especially with the changing dynamic in which health care is delivered. Seems that hospitals aren’t exactly the “place to be”, like they once were. Home health is on the rise. There seems to be a demand for Research Nurses. There are private practices, skilled nursing facilities, community health centers, schools, the list seems to go on and on. But the first question a lot of us will be asking ourselves after our final is, “Where would I really like to work?” The answer to that question is probably a lot closer than we might think. For myself, I look back on all of our clinical rotations. Do I want to be a Psych Nurse? Pediatric Nurse? Work in Labor and Delivery? Med/Surg as a floor nurse? Oncology infusion clinic? Wound Care? Dialysis? OR? ER? ICU? Which one of these felt right for me?
For me, one place in particular stood out.

The ER is supposed to be that place where there is a lot of chaos. It’s supposed to be loud and confusing and disorienting and scary and full of woeful sounds and indescribable smells. And it is. It is a place that any normal person would instinctively seek out the nearest exit if finding themselves suddenly planted there. That was not my experience. I found that the din of the confusion and urgency was almost calming in a way that allowed me to focus on what was in front of me. What needed doing. And being able to calmly and professionally carry out what would be expected of a nurse. I found it easy to be professionally personable with the patients in a way that helped put them at ease and gained their confidence. I sat down. I took the time to talk with them, on their level, and help get to the bottom of the purpose for their visit and help get them the treatment they needed.

Now all of that certainly sounds a bit… over confident. Was I at least a little bit nervous about the whole thing? Of course I was! I knew I’d be asked to do things that I’d only been “trained” to do or watched a video about or practiced on a rubber arm. But I was ready. Nervous or not. As I started two 18G IVs on a patient with a GI bleed in each arm, I reflected back to a practice lab and heard my instructor saying “The secret to a good IV start is confidence.” If someone with a medical emergency needs your help, there is no time for being nervous. It’s time to do what needs to be done.

At times I may have seemed too eager when wheeling the EKG machine, without a doctor’s order, into a room of a patient who’s monitored cardiac rhythm looked suspicious to me. The doctor would later confirm that this patient had some ST elevation, and changed the course of treatment because of these new findings. It would have been to easy to feel presumptuous and brash. Instead what I felt was relief that I had simply done something. I had a hunch and I went with it. It would have been much easier to stand by and be the observer. I loved being in the ER. I loved the fact that at shift change everything stops and all the nurses come together for an actual huddle to discuss what’s going on the department, what they can all do together as a department, and recognize each other for a job well done, or just a thank you for putting out a little extra effort when things got a little crazy. It had the feel of a team. Doctors, nurses, technicians, security, lab technicians, receptionists, everyone. They were a team. And the chaos felt very comfortable.

Are you comfortable in chaos? Does more structure suit you better? What clinical rotation left the biggest impression on you? Where will your nursing career take you? Where will you take your nursing career?