New Graduates

Nursing students new graduates New Graduate Supporters

What are some common interview questions?

How do you handle stress?
What traits do you find important in a colleague?
Speak to a time you showed compassion to a patient?
Tell us about a time you had to face a change and how did you handle it?
Can you recall a difficult situation and how did you handle it?
Speak to us about a conflict you had with a colleague. What was the nature of the conflict and how was it resolved?
What makes YOU the best candidate for this job and why do you want to work HERE?

What am I expected to be competent in when I first start working?

To begin, please don’t worry if you haven’t mastered many hands-on skills. Honestly, you’ll have the opportunity to practice on the floor. Here is a small list of things someone orientating you may expect:

You are willing to learn;
You understand the WHY behind what you are doing;
You will ask questions if you do not know something;
You have a safe knowledge of your medications – WHAT they are, WHY they are being given to your patient, WHEN to hold them and WHAT to monitor while the patient is on them. Additionally, that you review your medication practice manual in order to ensure you are preparing and administering certain medications safely;
You are willing to help your team when you feel you have time – this demonstrates that you are a team player, that your colleagues can depend on you, and it is the best way to learn and see more!

What should new grads expect transitioning to practice amidst a workforce burdened by the COVID-19 pandemic?

The current global healthcare crisis has intensified and destabilized the context within which our newest practitioners are transitioning from school to work. This rapid and dramatic shift in need and expectation is overwhelming many workplaces and placing unprecedented pressure on frontline practitioners. While new nurses willingly join the front lines to support patient care during these critical times, they face additional challenges as they are entering this unusually challenging workplace as fully responsible and accountable practitioners for the first time. The practicing nurses upon which the new nurses depend for collegial support and clinical knowledge transfer are stressed and excessively burdened by heightened workplace expectations and the daily witnessing of trauma both professionally and in their own personal lives. We want to minimize the anticipated long-term risks that can come from traumatic transitions. New graduates need to be directed to support tools. Fortunately, you are in the right place! Nursing the Future is an initiative that serves as a support network for newly graduated nurses moving into professional practice for the first time.

When will I feel 100% confident in my role as a nurse?

It takes at least 6 months to find your sea legs as a new nurse!!! Initial integration into practice TAKES practice – find a SAFE ENVIRONMENT to practice your fundamentals so that within the first few months you can ‘lift your gaze’ beyond WHAT you are doing to explaining WHY you are doing it – don’t expect yourself to be thinking too much about WHY you are doing what you are doing for at least the first 4 months, particularly if there are many new situations to which you are being exposed and expected to respond as a nurse. Your primary goal in the initial stage of transition will be to get to know the people you work with, understand the policies, procedures, understand what you have for resources and where they are, figure out what is expected of you and learn to fulfill your roles and responsibilities ‘without killing someone’

What is shift differential pay?

Shift differential is the extra compensation an employee receives for hours worked outside of 08:00 (8:00 am) to 17:00 (5:00 pm), Monday through Sunday. Some healthcare facilities operate 24/7, 365 days a year, and need to staff their locations beyond regular day shift hours adequately. Many hospitals pay a premium for working nights and weekends.You may also receive additional pay when taking on extra responsibility such as being a charge nurse.

What are the different staffing schedules available in nursing?

Depending on the position you were hired into, you could be considered full-time equivalent (FTE) or part-time equivalent (PTE). Other types of employment are permanent, temporary, and casual. There are benefits to all types of employment depending on your life circumstances.

- Full-time Permanent: These positions are usually the most sought after upon graduating from a nursing program as your debts are often higher and, quite simply, you need the cash! FT status means that you are guaranteed FT hours, you usually have a predictable ‘line’ (shift schedule), you receive full benefits and the assurance of permanent work. Countries have different representations of FT equivalent rotations and hours, so check with your employment agency to determine what that means for you!
- Full-time Temporary: These positions are beneficial when no permanent positions are available but you want FT hours. Most are long-term appointments (many for a year) and often they are positions that someone has left for ‘temporary’ reasons such a maternity, sick or other sanctioned ‘leaves’. You may not receive benefits (pension, health and dental) as quickly as you would if you were permanent so check with human resources for details if you choose this option.
- Part-time: In the posting for the position, it will tell you how many shifts per rotation are being offered. Always ask the manager of the unit if there is an opportunity to have shifts added by scheduling extra shifts or by picking up casual work.
- Casual/Relief/Agency: If the area in which you want to work has no positions available and you want to ‘get your foot in the door’, an option is to work casual/relief or to apply to work with an external nursing agency that provides staff for that institution. This may work very well for you if you are a flexible, easy-going person who doesn’t mind an unpredictable work schedule. A word of warning to the ‘planners’ out there – it is VERY DIFFICULT to plan your life if you work casual and want to work a lot. On the other hand, YOU are in control of what shifts you accept and what shifts you turn down.

How to manage a Code Blue as a nurse?

Let’s be honest – there is no such a thing as an EASY CODE. The problem with codes is that they are always different, always stressful and always unpredictable. Expect that you will be scared, shaky, unsure, and that you will forget something or do something out of sequence – MOST NURSES FEEL THIS WAY unless they deal with codes on a day-to-day basis;
Advanced Care Life Support (ACLS), Pediatric Advanced Life Support (PALS) or Intermediate Life Support (ILS) training will assist you to know what to do in the event of a code situation. These certification programs (often paid for by your employer) run you through ‘megacodes’ that simulate the ‘real life’ situation. For information on this, contact your manager;
If you are unable to access advanced life support courses, ask that the clinical educator or manager organize a ‘mock code’ for you and for the other nurses on the ward – make sure that you get a chance to ‘come upon’ (not know in advance what is ahead) the situation and practice what you would do;
Managing a code blue as a nurse includes: assessing the patient, activating the code status, performing chest compressions, communicating and sharing clinical information with the team, monitoring and recording the code blue process.

What does professionalism in nursing mean?

Professionalism in nursing is complex. Often understood as an individual’s adherence to a set of standards, code of conduct or collection of qualities that characterize ‘best’ practice (aka evidence-based) within a particular area of activity, professionalism also speaks to the behavior undertaken while enacting skills and knowledge. Being professional means you fully understand your role as a caregiver on an interprofessional health care team and that you appreciate how your actions influence the health care experience of both the client and your colleagues.

Any advice for charting?

“If you didn’t chart it, it didn’t happen” - you’ve probably heard this statement many times by now. Well, it’s TRUE. If there was ever a time where the details related to specific client situations were important, it’s NOW. Your charting will most definitely be examined to help piece things together should anything related to your patient become an issue.Let’s review a few charting tips:

𝐅𝐎𝐂𝐔𝐒 - the subject/purpose of the note (e.g. acute change in LOC);

𝐃𝐀𝐓𝐀 - a narrative that contains subjective & objective information;

𝐀𝐂𝐓𝐈𝐎𝐍 - what did you do about the above findings? This is where you document your intervention (e.g. notified doctor, administered analgesic);

𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐄 - how did the patient respond to your action?

Both subjective and objective data should be included (use the patient/family member’s words whenever possible);
Minimize double charting/documentation - refer to other forms in your nursing notes;
If you are charting by hand, ensure your writing is legible and you sign off with your initials/signature and/or designation;
Ensure you fill out the patient’s signatory sheet to show you were involved in their care;
Document as soon as possible after your care/an event (even with a notepad in your pocket until you can get to the chart);
Use chronological order when documenting – if you MUST enter late, ensure you identify it as ‘Late Entry’;
Document any verbal or telephone orders from a physician – make sure you repeat back the order to ensure accuracy and explore your unit/institution policies around verbal/phone orders;
Because your documentation is a legal document, no erasing is allowed! IF you make an error, cross it out, write “error” beside it, and initial it. Otherwise, write in pen! The COLOR of ink is sometimes stipulated by the institution but if not, the best is black as it does not fade.

As a student/nurse entering an Indigenous community, how can I respectfully learn to be culturally appropriate and sensitive of the Indigenouspeoples?

As a student or staff member, your orientation to the unit will include a manager or clinical coordinator that you can ask questions of prior to entering the area, including finding out which cultural communities are served by the area you are working in. Alternatively, you can speak to the staff you work with and ask questions about embedding respectful cultural knowledge (including local language) in your practice. For some areas, there will be staff orientation material created for the purpose of increasing cultural safety for communities who you are about to engage with. It is worth spending some time researching the area you are entering, noting the peoples and history whose traditional lands you are working on. As well, humbling yourself when working with Indigenous cultures (or any culture) is always appropriate – ask THEM to ‘teach’ you some words that would help you help them. Keep a book of culturally appropriate language phonetics to assist you to remember. Ask anyone with whom you are culturally unfamiliar if there are traditions or practices that you could include in their care.

I’m a new graduate nurse and I want to write the NCLEX in French. What resources are available to support me to prepare and then to write this exam?

There are certainly more English resources available to date. However, some great French-language resources to consult are the Exam Plan and the Review Course by NCSBN.

I’m a Francophone new graduate. Should I take my National Council Licensure Examination (NCLEX) in French or in English?

This is a great question and a very difficult decision to make. At the end of the day, regardless of what you have heard about the French version of the NCLEX, it is a good idea to write it in the language you are most comfortable in. Once you decide, don’t think about ‘what if’ and continue to use available resources in the language you have chosen.

Can I refuse to care for a patient who makes racialized comments? What are my options and resources if I encounter this?

All nurses in Canada are protected under the Canadian Human Rights Act (the Act). Within the Act, harassment is defined as “improper conduct by an individual, that is directed at and offensive to another individual in the workplace.” Offensive conduct includes discriminatory acts, comments, and displays. As such, a patient/client making racialized comments towards a nurse is considered harassment.

The Act states that the conduct must be repetitive in order to be considered harassment. This means that the patient/client makes a racialized comment more than once. If you have asked a patient/client to NOT make racialized comments and they continue to do so, it is your right to refuse care. That being said, a single act of racism can be considered harassment if it is so severe that the nurse is significantly impacted for a longer period.

In addition to the Act, nurses in Canada are covered under the Work Place Harassment and Violence Prevention Regulations. These regulations protect workers by outlining what is considered a “work place,” further defining acts of harassment, and your employer’s obligations to ensuring a psychologically safe work place.

If you encounter a patient making racialized comments, the first step is to approach your nursing supervisor to discuss changing your patient/client assignment. Other people that you can reach out to as resources include your local nursing union and regulatory body.

References:

Canadian Human Rights Act
Is it Harassment? A Tool to Guide Employees
Work Place Harassment and Violence Prevention Regulations

Should I work in the city first or go straight to rural/remote setting if that's my ultimate goal?

This statement depends on the setting. RESEARCH IS KEY. Consider the remoteness of the setting. A medium distance rural/remote setting with a mid-sized hospital is a great first new grad job because of the wide variety of experience you'll gain and the opportunity to learn from deeply experienced rural nurses. We would recommend (and many remote settings require) gaining a couple of years’ experience in a better resourced/supported setting prior to moving to a truly remote location with less back up.

How do I find a job position in a rural area?

To start, many positions are advertised by regional health authorities. An added enticement for a career in this field is that many governmental and non-profit agencies offer incentive programs. Further, some areas have RN/RPN locum programs where you can search for jobs and go out on a minimum time assignment. Remember, you'll be helping an underserved community.

What education do I require after my basic nursing program to transition to work in a rural or remote area?

Research your desired site first and read up on some of the current external postings. Here you can review the position summary and qualification requirements, whether they are mandatory or suggested. There are no certifications specific to rural nursing. Many different certifications can be APPLIED to rural nursing. Think specialist-generalist range: Basic Life Support (BLS), Advanced Care Life Support (ACLS), Pediatric Advanced Life Support (PALS), Trauma Nursing Core Course (TNCC), Managing Obstetrical Risk Efficiently (MOREOB) Program, Neonatal Resuscitation Program (NRP), etc. In primary care settings, the Certified Diabetes Care and Education Specialist (CDCES) credential is useful but usually requires experience before completing. Many of these courses are available by distance in colleges throughout the country.

What is the process if you sustain a workplace injury?

Ensure you are familiar with the process to be taken in the event that any staff, patients, or visitors requires first aid while on site. The algorithm for your worksite should be posted in a common staff area for quick reference. If not, ensure you ask where to locate this information. Potentially, bring it up as a Workplace Quality Improvement Idea to have this posted somewhere central for safety.

Should new grads take any job that is offered or wait for the right one?

Evaluate opportunities, not based on whether they are exactly what you need for your long-term goals but based on whether you’ll GAIN SOMETHING that will be useful later. In nursing, there are skills you may learn in one setting that aren’t as common in another – soak up all learning like a sponge for that first year. For areas that you aspire to work in (i.e., emergency, critical care, high risk obstetrics, etc.), talk to expert nurses in those areas and ask what skills and practice experiences you should be getting to prepare you to work there. There may also be several factors to consider when selecting a job such as where you live and the opportunities for an available position and your current financial situation. Think about what is best for you but think long term!

Any helpful tips for new graduates starting orientation?

- Look up the most common diagnoses and their corresponding medications seen on your unit – focus on learning how these connect. Once you review these BEFORE starting on the unit it will help your confidence;

- Determine the top 5 skills you will need to perform on this unit – spend a week doing ALL of these skills for the nurses until you can do them in your sleep;

- ASK ASK ASK! No one expects you to know the answer to everything. In fact, no one can in the nursing profession. So ask as many questions as you need to during your orientation so you will be well prepared for being on your own;

- Carry around a small notebook so you can write down any key points you learned from orientation. This will help you feel like you have somewhere to look before searching for a team member to ask. Review your notes each day and gradually make a ‘little black book’ (could be on your phone) of important information about the unit/staff/locations of things/common processes and protocols/frequently delivered meds, etc.;

- If you still feel that you need a few more orientation shifts, discuss with your educator, preceptor/mentor and arrange a meeting with your manager to request them! You can explain what you hope to achieve and your manager should want to invest in your success.

When I go on break how much information do I need to tell the covering nurse?

You want to make sure that they are readily available to assist your patient if something comes up. It is best to state the patient’s diagnosis, code status, mental status, mobility/activity level, diet, drips, and any abnormal vital signs that have stabilized or anything else to look out for and need to do. Tell them the thing you are MOST concerned about as you leave this patient.

What are some helpful questions to ask during handover report to better prepare me for my shift?

It is often helpful to ask questions when receiving handover report if they have not been addressed. The more you know the better care you will be able to provide to your patient.
- “What is biggest concern you have as you leave this patient now?”
- Is the patient alert and orientated?
- Are their communication barriers with the patient or family?
- Does the patient have any essential visitors?
- How does the patient mobilize? Are they a falls-risk? If yes, have falls precautions been set-up?
- Is the patient a telemetry or non-monitored patient? What were the LAST vital signs of the patient?
- Are there any outstanding orders that need to be completed?
- Does the patient have any wounds/incisions – when is the next dressing change due?
- How do they take their medications? Are they an aspiration risk?
- Does the patient have pain? How are we controlling the pain? When is the next dose due?
- Are they on IV antibiotics? When is the next dose due?
- Does the patient have any type of testing that they must be NPO for?
- Does the patient have an informed consent signed? (i.e., patient is receiving a blood product or awaiting surgery)?
- Anything else I should know?

How can I give a good nursing handover report?

As a new nurse, one of the most nerve-wracking things is giving a handoff report because you don’t want to miss important information, but you don’t want to give too much or too little information. Nurse bedside shift report, or handoff, has been defined in the literature as a process of exchanging vital patient information, responsibility, and accountability between the off-going and on-coming nurses in an effort to ensure safe continuity of care and the delivery of best clinical practices. Nursing report is given at the end and/or at any point during the nurses shift to another nurse that will be TAKING OVER care for that particular patient. Most nurses use the formal SBAR tool as a guide to help them give report, which is highly recommended. SBAR stands for:

S = Situation
B = Background
A = Assessment
R = Recommendation

SBAR is a reporting technique used in nursing fields for easy communication amongst the interdisciplinary team for providing pertinent details regarding a patient’s condition. It is also a highly useful mechanism in providing adequate communication techniques during critical situations that require an immediate response from the physician. To remember to include all salient information, a systems approach is recommended (i.e., to start, psychosocial: patient had significant pain overnight treated with ______, then include/skip those ‘systems’ that have something to share).

See some sample SBAR forms below:

What are some of the biggest missteps that new graduates may make once they begin their professional role transition?

New graduates often struggle to:
- Critically think through situations because they are focused on completing their patient ‘care’ and the skill/tasks patient care;
- Manage their time between multiple patients with competing priorities;
- Balance their lives - putting too much on their plate personally and professionally (i.e., picking up too much overtime and not allowing themselves to rest between shifts and reflect on their practice);
- Sustain their energy through the stages of transition – remember that A LOT of energy is being consumed during transition, particularly Stage 1 (1-4 months) – you need to prepare for the level of exhaustion;
- Understand how being a ‘professional’ is different than being a ‘student’ – as a graduate you are now a visible representative for the profession. Posting sensitive information on social media (this is not solely patient information it can also look like controversial statements) requires intent and discernment;
- Know when they can use their personal technology (i.e., cell phones) at work;
- Maintain professional relationships at work and not get caught up with unit gossip/drama – think about how you would feel if YOU were the one being talked about in that way.

How will abbreviated senior practicums due to COVID-19 impact on my ability to get a job after graduation?

You may hear that many graduate nurses are experiencing longer than anticipated unemployment times after nursing school. However, pandemic demands have only exacerbated chronic staffing problems so this experience may look different now. The reality that you lost any amount of practicum hours may seem overwhelming but there is no evidence to suggest this will affect your future job applications. After clinical placements were placed on hold, nursing faculty worked to find adequate online solutions and ensure all students could remain on track for requirements needed for graduation. You would have fulfilled your School of Nursing’s requirements and should receive notice of your program completion. Just continue to evaluate your strengths and weaknesses in YOUR PRACTICE and ask for assistance up front. The experience of transition might take longer or be more stressful if you have not had ‘face-to-face’ practice opportunities (more simulation and lab) so be prepared for this – talk to your educator about what is realistic when it comes to expectations of your performance and your progression.

Are you suffering from transition shock? What can this look like?

Most graduates begin to experience transition shock after the orientation and supernumerary period has finished, and the daily grind sets in.

Common signs to watch for include:
1. Feelings of anxiousness
2. Fear of failure
3. Inadequacy and ‘imposter syndrome’
4. Isolation
5. Lack of hope and/or
6. Fatigue.

Why do people say we are in the ‘real world’ now?

You’ve spent four years in nursing school, reading, training and practicing. To a degree, you’ve been ‘protected’ by the fact that you are still in a learning mode – not everything you need to know to practice efficiently or effectively can be ‘taught’ in school. Suddenly, you’re working under your own license, in practice settings where WHO you care for and WHAT you are responsible for is less able to be controlled. Most often the ‘real world’ is different than what you have been accustomed to because the emphasis is now on performance, not learning. For example, you might learn nursing skills a certain way in nursing school, only to find out that some changes (maybe a policy is different from institution to institution, or safety procedures are dictating the steps the institution must take in performing that skill) have taken precedent once you get on the job. Just remember that nurses are expected to have the most up-to-date knowledge and clinical skills when providing client-centered care and as a new graduate, you actually come out of nursing school armed with that knowledge. Sometimes the ‘real world’ isn’t on top of its game either – it may be that the way things are being done need to be revisited. If you believe a practice is outdated, approach the educator with evidence that might advance the way they do things in practice.

How do I deal with pre shift anxiety?

Pre-shift anxiety is something that many new nurses (and sometimes experienced nurses!) feel. We want to help you start learning, dealing and coping with these feelings and emotions! Remind yourself that you are safe and not alone. Here are some ideas to help for both day or night shift. Mental preparation makes us feel hopeful and confident.
- If there is something from your last shift that confused you or something that you found quite difficult, review the theory on it or talk with a more senior nurse about what you might have done differently. This will help you feel more prepared the next time it arises.
- Take the time to breathe deeply on your way to work to allow yourself to focus better.
- Aim to go to bed on time the night before a shift to ensure adequate rest.
- Arrive to work roughly 15 minutes early in order to put away your belongings and check your assignment.
- Remember a situation where you were PROUD of your actions. This positive self-talk can lead to improved self-esteem.
- For the first few months, figure out if there is someone you can text or call if you run into a situation that overwhelms you – this might be a senior nurse or another new graduate

Please let us know what things you do to help deal with your own pre-shift anxiety. Leave it in the Question Box so we can the information to this question for the others nurses needing help.

What do I do if I see practice that is suboptimal?

Here’s an exercise: Identify 4 VALUES related to your practice and professionalism that you hold dear. Here are some examples:

o Humility
o Strength
o Courage
o Empowerment
o Respect
o Advocacy
o Support
o Commitment
o Equity
o Inclusivity
o Cultural safety
o Cultural competence
o Accessibility
o Resilience

REMOVE two of those values, leaving you with two remaining values you want to uphold in your practice. Now, as hard as it is remove 1 more…..THIS VALUE is an absolute priority for you, so hold on tight to it. As you move on in your practice, ensure that you see this value playing out in all that you do. An example might be respect for others – ensuring that all your interactions with co-workers, patients, families and communities are framed by respect ensures you will walk away from those interactions with a sense of integrity you can be proud of. As our values (that which we hold most dear) erodes, so does our joy, our confidence and ultimately our sense of ourselves.

What factors FACILITATE and IMPEDE resilience in new nurses?

The construct of resilience has been credibly researched and is cited as one factor that facilitates a successful transition, job satisfaction and career longevity. The table below highlights the research of Wahab, Ang, & Lopez (2017) and the main factors affecting the development of personal resilience.

Reference
Wahab, S., Mordiffi, S, Ang, E. & Lopez, V. (2017). Light at the end of the tunnel: New graduate nurses’ accounts of resilience: A qualitative study using photovoice. Nurse Education Today, 52, 43-49. doi: 10.1016/j.nedt.2017.02.007

When does the process of professional role transition begin?

Usually once the new nurse leaves the safe and predictable confinement of their nursing education program. In other words, after completing their final practicum and entering their New Graduate Orientation. Having said this, the graduates often feel ‘safe’ while still in a supernumerary position or orientation because they are in the familiar learner role. It is when they are ‘on their own’ that they feel the true weight of the responsibility of their role. The longer you can draw out the support, even minimal support, and the slower the withdraw of that safety net, the less transition shock the graduate will experience.

What factors influence a new nurse's transition experience?

The majority of graduates transition into professional practice through the dynamic, fast-paced and relatively unforgiving environment of acute-care:

1) acute-care patients are more clinically complex and generally sicker than ever;

2) the care resources available to nurses have not kept pace with the demands of nursing work;

3) new nurses are not entirely prepared to work in ‘teams’, therefore their comfort level with and knowledge of task delegation, supervision of unlicensed staff and workload collaboration with nursing and allied health colleagues is extremely limited;

4) students are not consistently expected to integrate population health indices in their patient/client care (i.e. the majority of acute-care admissions are geriatric patients yet the issues related to gerontology – for instance the propensity for dehydration in the elderly – are not comprehensively considered in the daily care planning of the aged acute-care admission);

5) the education of nurses has advanced in the direction of a primary healthcare focus, while the environment within which new practitioners work remains based upon a biomedical ‘illness’ model of care that focuses nursing work on ‘doing’ rather than ‘knowing’; AND

6) the varying scopes of practice of nurses, and the emphasis on power rather than value sets nurses up to compete rather than collaborate on ways to optimize the care of their patients.

The factors influencing a new nurse’s transition involve stability, consistency, predictability and familiarity. Stability refers to that which is unlikely to change or ‘deteriorate’ and includes aspects of your personal as well as professional life. If your work life is less stable, then you want to balance that with a more stable personal life. Patients who are acutely ill, require high level decision making or advance problem solving, or who’s conditions are volatile and subject to rapid change, would not be the ideal demographic for a new nurse. Consistency is the experience of being exposed to a similarly presenting event/situation/concept/idea that affords you a level of familiarity and predictability. From a purely logical perspective, consistency is defined as that which does not contain contradictions or significant differences. Floating from unit to unit or hospital to hospital on a weekly basis would not provide you with consistency. Familiarity for the new nurse speaks to that saying: ‘I’ve seen this before’ and perhaps even ‘…and I know exactly what to do about it’!! If a senior student is employed, or spends their final practicum on the unit to which they plan to transition, things will be familiar. Even knowing WHERE to get what they need to do their work is a relief of transition stress. Last but not least is predictability. For a new nurse, this concerns their ability to know:

1) WHAT they will do (what level of performance is expected of me now that I am a graduate nurse; what do I need to ‘do’ in this role; am I comfortable enough with those in charge to be able to tell them when I am in ‘over my head’),

2) WHERE they will do it (where am I working; am I going to the same workplace every shift or floating to multiple units; if I have to start as a casual employee how can I get enough hours without exposing myself to too many unfamiliar workplaces),

3) WHEN they will do it (am I working 8-hour or 12-hour shifts; what is the rotation; when ‘this’ happens [a code, a death, a distraught patient, a diagnosis of an sexually transmitted infection, a suicide in the community] how do I respond),

4) with WHOM they will do it (who will I be working with, who do I go to if I have questions, who can fire me, who can I trust), and

5) HOW they will do it (what are the differences between what I did as a student and what is expected of me now as a graduate nurse, what will I do if I come up against something I have never done before, are things done differently here relative to where I practiced as a student).

What do I do if I see unethical practice from a senior nurse?

This is a tough one. Practice that is suboptimal (best of a bad situation) or unethical (worst of a bad situation) is a reality – this can speak as much to workload or sociocultural issues in the workplace as it can the individual moral practice code of the nurse. Unfortunately, ethical issues in nursing practice can be under attended to because they are sensitive to deal with, and people often do not disclose the challenges with practicing ethically that they encounter. But this aspect of practice can create tremendous stress for the new nurse as they seek to do ‘what is right’, advocate for and protect their patients, and work alongside the colleagues from whom they desire acceptance and a sense of belonging. It is best to familiarize yourself with what your licensing body has to say on their website about their expectations surrounding one’s Duty to Report and to reach out to senior nurses you trust for their thoughts.

Do nurses get breaks on the job?

In order to justify your offered breaks you can review your union’s collective agreement. Although frustrating, nurses often go without breaks. However, this may be in response to a multitude of reasons. For example, a new admission from the emergency department, an increase in patient acuity, patient crisis, emergency procedure, locating a physician, stat orders at shift change, workload, charting, code blue, staff shortage, meeting. Employees are encouraged to take their breaks when safely able to do so.

Should I consider casual, part-time, or full-time work after graduation?

Some new nurses find it beneficial to control their hours and workload intensity during their initial adjustment into a workplace. The challenge with working TOO MANY hours is the level of exhaustion that can feed higher error rates and poor coping skills. The challenge with working TOO FEW hours is the inability of the new nurse to gain a comfort level, and therefore a confidence level, in their developing practice. You need to find YOUR rhythm, but it is usually somewhere in between. Remember that the stability, consistency, familiarity and predictability of your employment are as important as the number of hours worked.

What are my rights and responsibilities regarding refusing unsafe work?

A nurse has the legal and ethical obligation to refuse an unsafe assignment that compromises patient safety. It is essential that you make your concerns known to your employer, your union, or licensing body and document the steps you have taken so that you can refer to them later. While leaving a patient without a caregiver is neither safe nor ethical, you are equally obligated to seek out assistance in caring for a patient situation that you feel is beyond your capacity, or finding a replacement caregiver who is more capable of caring for that situation WHILE you do what you can to ensure the patient is safe. If you have an institutional ‘safety process’ (a number to call in the case of an unsafe situation at work, or a reporting system for unsafe workplaces) you should access that. If there is no formal safety net for your practice, you need to contact the nurse in charge, then the manager or administrator on call (simply call switchboard and ask for the Administrator on Call) to report your concerns.