Advice for newly qualified Nurses

1.16 Don’t be afraid to ask!

My first tip, which is definitely the most important if you take nothing else from this video, please do not be afraid to ask questions and to ask for support.

Just because you're qualified, people aren't gonna expect you to walk in and know everything and be able to do everything and just go off and be completely independent from day one.

Nobody expects that of a newly qualified nurse.

They know you're gonna need support, they know you're gonna have questions, so please don't be afraid to ask.

Don't be afraid to speak up if you're not sure about something, you know, don't worry about looking stupid, thinking, you know, ‘I'm qualified I should know this’.

You might just come across some things that you've never dealt with as a student nurse, so if you've never dealt with it before you're not gonna know how to handle it and that's absolutely fine!

You’ll be much better off just putting your hand up and saying ‘I don't know how to do this, can you help me with this?’ than trying to do it on your own and doing it wrong.

One of the really important things within the NMC code of conduct is that as a nurse you work within your limits and you know what you're capable of and that's what you do.

For example, as a student, if somebody said ‘do you want to go and give an injection for the first time?’ you probably wouldn't just say ‘yes, let's go and do it now’.

You'd probably say ‘can you talk me through it first, give me a chance to read up about it, can I watch you doing it first?’ and that's exactly the same thing when you're a qualified nurse.

If you've never done something before and you don't know how to do it just say.

I'm actually super excited because, obviously, we're gonna have some newly qualified starting on my ward soon and I'm really excited to be able to support them and help them to feel as confident as they possibly can because I know how terrifying it is walking into a ward on that first day and going ‘hi I'm Chloe, I'm your new staff nurse’, I was petrified, absolutely petrified!

You know, you could have been the most competent student nurse that has ever lived and it's still a completely different ballgame when you step onto that ward for the first time as a qualified nurse, everything just feels really different.

So a really good example of this for me is, as I said I'm a mental health nurse and on mental health wards you'll have what is known as kind of like intentional rounding or intermittent checks, which is basically where either every hour or every 15 minutes, you know, depending on the ward, depending on the risk, you'll go around and you just need to kind of eyeball every patient.

You need to know where they are and just check that they're safe, basically. And I remember doing this for the first time as a qualified nurse and I was petrified.

I was literally like double, triple checking people if people were asleep, I was standing there for like a good 30 seconds to double-check they were breathing, and it was something that as a student nurse and as a support worker - because I used to do bank shifts as a support worker while I was training - I would never have doubted myself, and yet when I was doing it for the first time as a qualified nurse, like, I would see breathing and then I'd be like, but are they really breathing?

And then I'd, like, keep checking something that was basic as that, and I was still really scared to do it for the first time as a qualified nurse.

It's a completely different ballgame, so just don't beat yourself up over it.

Also, meds is something that terrified me when I first started because the trust that I trained in, you had to have two nurses to do medication or a nurse and a student, but even if you were qualified you still had to have two nurses to do medication, and then the trust that I now work in is only one nurse to do meds.

So, to go from always having a nurse there doing it with me and kind of throughout my career kind of expecting that that was the norm, to then go into a trust where just one nurse gives meds, I was terrified even though I knew I could do it, and I knew I was competent - I was still absolutely terrified!

What I'm trying to say is it's natural to feel nervous but you can do it, you've got this, you've qualified as a nurse so you're clearly competent.

But if there's things you don't know and you need support with, just say.

4.38 Stick to the terms of your preceptorship

I already mentioned this thing called your preceptorship which you likely would have heard of already, but if you haven't, it's kind of, I don't know how to describe it; it's basically like the period when you first qualify as a nurse, you're known as a preceptor nurse or preceptorship nurse, similar to if you qualify as a teacher, for that first year you'll refer to as NQT, newly qualified teacher.

It's essentially that but in nursing, so it's this period of time when you're a fully qualified nurse but you're brand new.

There'll be extra things in place for you as a preceptor nurse, so one of the things that I would definitely recommend is in your first week, have a chat with either one of the more senior nurses or your ward manager, service manager, whoever, find out what safeguards and what extra support are there in place for you as a preceptor nurse.

This is gonna vary massively depending on where you work but it could be things like not being able to do nights while you're a preceptor nurse or not being allowed to be the only qualified on shift.

In some places you can't be the nurse in charge if you're a preceptor nurse, you have a smaller maximum number of patients that can be allocated to you, maybe something like you're not able to be moved to a different ward if there's staffing issues and another ward needs an extra nurse, as a preceptor nurse the service aren't able to move you.

Whatever it is, find out what things are in place for you as a preceptor nurse and then make sure your trust sticks with it, even after a few months it can be easy to, kind of, fall into the trap of being like, ‘well I feel like I could do that so I'll do it even though I'm a preceptor nurse’.

But the trouble with that is that you might end up in a situation later down the line where actually you don't feel competent to do it or you do want to make use of the safeguards that are in place for you as a preceptor nurse, but because you've already allowed management to drop some of them they feel like it's acceptable to drop some more.

I think sometimes, as a newly qualified nurse, you almost shoot yourself in the foot a little bit by being too competent.

I had this with my first night shifts - I was promised that on my first set of nights I would have a second qualified nurse with me even though we only normally run on one qualified nurse at night, and that's just basically because obviously during the day I've got support from the MDT, management, there's normally another nurse around, you know, there's other people around, but obviously nights you don't have any of that.

So that's what I was told, that I was gonna have a second nurse for my first set of nights as a qualified nurse, and then it didn't happen.

And essentially, what my manager turned around and said was that, you know, ‘we knew you'd be okay anyway’ and it's like, yeah, but that's not the point, like, I needed that support.

And then, actually this is a really good example of this because there are clinic checks that we do on our night shifts that I knew nothing about because I've never done a night shift before so I didn't do the clinic checks for the first few nights, and the only time I found out that that was a thing was when I got an email from my manager saying ‘why haven't you done them?’ and I was like, because I didn't know I had to do them, because nobody in showed me!

So just please make sure when you're a preceptor nurse that you take advantage of all of the extra support and the safeguards that are in place because they're there for a reason.

You know, yes you're a fully qualified nurse, but you still need a bit of support and you've still got a lot of learning and development to do, so make the most of that and make sure your manager does too.

I think this is particularly important if your first job as a qualified nurse is on a ward that you have already worked on previously, whether that's been as a student nurse or if you've been doing shifts as a support worker there previously, I think management can often fall into the trap of being like, ‘oh well, we know them, we know they're really good’ and then you get a little bit less support, and it's not an intentional thing, it's not like they're deliberately thinking, oh, you know, we'll give them less support, but because they know you and they know you're competent it kind of accidentally happens.

But just be firm and say, you know, even though I've been here as a student, I'm now a qualified nurse and it's a completely different ballgame and I need that extra support.

Just be really firm and make sure you get the support that you, a) want and, b) need.

7.56 Your preceptorship workbook

Going back to the topic of preceptorship; so you will likely have some kind of preceptorship course/ preceptorship module/ preceptorship program or whatever they want to call it, you will likely have some kind of like workbook sort of thing similar to when you were a student and you had like a list of competencies that you needed to get signed off and things like that, you have something quite similar as a preceptor nurse.

Unfortunately, mine is still with my service manager because I only handed it in last month so I can't show you mine, but actually thinking about it there's quite a lot of information I wouldn't show you in there anyway.

But essentially, it was like a workbook that I was given and mine had 17 different sections, so one of those sections was the Mental Health Act, one was infection control, one was safeguarding etc, and under each heading, there was a list of competencies that I needed to prove I was competent in. However, what's slightly different about this as opposed to when you're a student, is that you actually need to evidence this.

So, an example of this, underneath the risk section was that I needed to demonstrate that I could complete a datex, which is an instant report. So I had to tick to say, yes I know how to do a datex, but then I also had to print out a couple of my datexes and put it in as evidence with that section.

So, whereas when you were student just your mentor signing saying ‘yep, she's done that, she's competent to do it’ would be enough, in your preceptorship you will actually need to print out the evidence.

So I put my preceptorship workbook in a folder so that I could put all my evidence with it and I had one of those big ring binders, you know, the ones that have got like the little, like a click thing to hold it all in place, I have one of those and it was absolutely jam-packed full of stuff.

Your preceptorship is gonna vary massively depending on where you're working, which trust you're in, different trusts might have their own, different areas might have their own,whether you're NHS or private, preceptorships are gonna differ.

So if you haven't yet interviewed for your first job as a qualified nurse, it's well worth asking about their preceptorship program, how does it work, what support you get, what safeguards are there in place.

It's a really good question to ask at the end of an interview because it shows that you're thinking about going to work there.

How mine worked was about, probably about six to eight weeks after I started my job, I went on a week-long preceptor ship week - obviously!

And it was basically Monday to Friday, 9:00 to 5:00, and there were loads of different kind of like seminars, training sessions, group exercises, all different kind of things that were either mandatory training that I needed to complete as a newly qualified nurse or just extra sort of support and kind of like an introduction to being a qualified nurse.

It was also just a really great way to meet other newly qualified nurses in my trust because, for anyone who doesn't know, I trained in London but then I moved up north, I moved to Manchester when I started my job so I didn't really know anyone, so it was a really great way to meet some other preceptor nurses.

Other trusts do their preceptorship quite differently so I know in the trust that I trained in, rather than having a week-long course there was one day a month for a whole year, and obviously there's pros and cons to both but that's how mine was my was, just a week all in one go.

And then you kind of got sent away with the workbook, to complete it with the support of one of the senior nurses on your wards.

So I started my job in September and then I went on my preceptorship course in November, and then I've literally just handed in my preceptor folder last month at the start of June, so it probably took me about six to seven months to complete my preceptorship.

They don't recommend you complete it any sooner than six months and you should really have completed it within twelve months.

For me it was quite time-consuming because there's just so much evidence you need to gather, obviously I have already mentioned the datex thing, another one was that I have to evidence that I understood the Mental Health Act tribunal process, so I did a tribunal report for one of my patients and printed that out and put it in there.

There was also a competency about understanding the aseptic touch technique for dressing wounds and things like that so I photocopied the poster that we have in our clinic room and put that in there to show you that I had an awareness of that.

My best advice for actually completing your preceptorship workbook, if you've got one, is to kind of go through it as often as you can and make a list of the evidence that you need, because mine definitely was so much more time-consuming because I didn't realise that I needed the evidence for something until after I'd done it, and then I was having to go back and hunt through it, whereas if you've already got in your mind sort of five or six things that you need at any one time, when you do it you just automatically print it out and put it in your folder and then kind of look for another thing that you can start having in your mind.

That's one thing I wish I'd done that I'd had more of, like an awareness of what I needed so that I wasn't having to go back and hunt for things that I knew I'd already done, I just didn't have the printed evidence to put in my folder.

11.57 Take your breaks!

Moving on from preceptorships...

So, the next thing that, again, I cannot emphasise enough - take your breaks!

Take your breaks, you need a break, take a break!

And this is something that I am definitely guilty of doing myself I don't always take my breaks because unfortunately, you know, I'm aware that it isn't always possible but go out of your way to have your breaks because you don't want to be getting burnt out.

There are some shifts when I go home, if it's been a really really busy shift and I haven't had a chance to have a break, I sometimes find that I'll get home after a twelve and a half hour shift and I literally can't function, I can't concentrate enough to, like, watch TV or read a book, I'm not in the mood to have a conversation with anyone and then it means that my work life is affecting my personal life, which it really shouldn't do.

So, I know it isn't always possible but please try your absolute hardest to take your breaks.

You don't want to be getting burnt out - I mean, you don't wanna be getting burnt out where any point in your career, but you definitely don't want to be getting burnt out as soon as you start your career.

They are important, they really are.

I think sometimes, even though it might feel like you're really busy, you're actually gonna be more productive if you've had a break, you know, being really stressed and hungry and thirsty, it's gonna make you less productive.

So even if you don't have time to take your whole hour break, take half an hour, go and have a cup of tea go and have something to eat and when you come back you're gonna be more productive.

13.09 Ensure you’re being supervised!

Another really important thing to consider is supervision.

Please, please, please make sure that you are having supervision!

You should be having two kinds of supervision; you should be having line management supervision and clinical supervision and they should be separate things, I know some places will try and combine them together but they should be separate for qualified nurses.

The difference is that management supervision, the agenda is set by your manager so it's gonna be things like your performance, sickness, annual leave, if there's been any changes to policy recently, any policies that in general as a trust you haven't been following correctly.

It's kind of a way for management to tell you things that you need to know as well as kind of evaluate your performance within the team.

Whereas clinical supervision, it's much more about you as a person and you as a clinician, so you set the agenda, you decide what you want to discuss and it's all about having a space for you to sit and reflect on everything that's going on with a more senior nurse or a more senior anyone - you can actually pick your clinical supervisor and as long as you can kind of justify what why you want that person you can really have anyone.

I mean most people are gonna have sort of nurses more senior than them but you could have a psychologist, an OT, a doctor, so long as you can kind of say ‘this is what I'm hoping to get out of supervision from this person and, you know, this is why I want to have it with this person’ you can pretty much have anyone as your clinical supervisor providing they're willing to supervise you, of course.

It's a good idea to choose a supervisor who will be both beneficial to your career now but also your career in the future, you know, where are you working towards?

Potentially having a clinical supervisor from an area that you're hoping to work towards will be quite beneficial in terms of your long term career development.

It's also really important to choose someone that you feel comfortable with, someone you can have a bit of a rant and a bit of a vent to because we all need that sometimes, but also someone that you feel like is gonna let you have that space to have a bit of a rant but then bring you back and kind of go, right, what can we do to make this better?

Make sure that you've thought about what you want to discuss before you go into clinical supervision because that's how you're really gonna make the most of it.

So maybe think, I've got this patient at the moment that I'm really struggling with, you know, I don't know how to help them, you can maybe print out your care plan and take one of your care plans with you to try and ask them to go through it with you see if they can come up with any ideas.

If you are really struggling to connect with a patient, maybe if there's been an instant on your ward that you recently that you found really difficult, discuss that with them.

And if you've made a mistake recently - because we are only human, we will make mistakes sometimes - maybe go in and just kind of have it as a reflective space with them and just think how did this mistake happen, how can I stop it happening again?

You know, really make the most of that time, don't just walk into it like absolutely clueless and expect your supervisor to sort of give discussion points. Clinical supervision is much more about you and what you need, so they're gonna expect you to come in with a couple of things that you want to discuss.

I could ramble on for ages but I think those are the main things that I wanted to mention.

If you are already a qualified nurse and you're just watching this because you're curious and you have any tips, feel free to leave those in the comments down below - let's just have a chat, like even if you're a student nurse that it isn't qualified yet and you're just watching this, let me know your thoughts!

I always love having a chat with you guys in the comments below on these videos.

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