Six Tips to Survive Your First Year as a Hospital RN

The first year on the job is often the toughest for new nursing graduates, especially those who work in hospitals. In fact, new nurse graduates account for more than half of the turnover rate in some hospitals, according to a study published in 2007 by Johns Hopkins University School of Nursing researchers.

“There really are multiple reasons for [the first-year exodus],” says Patricia Benner, RN, PhD, professor at the University of California, San Francisco and a senior scholar at the Carnegie Foundation for the Advancement of Teaching. “One is that nursing practice is incredibly complex. Over the past 60 years, the transfer of responsibility to nursing from medicine has been incredible. I think society doesn’t typically recognize that.”

Because the sickest patients are in the hospital, hospital RNs need good clinical judgment and the ability to recognize when a patient needs immediate intervention -- challenges that are especially pronounced in a nurse’s first year of employment.

So what can you do to make your transition from nursing student to working nurse easier and your first years on the job more satisfying? Here are some issues to ask about and consider before and after taking the job.

Ask About First-Year Nurse Turnover Rates

High turnovers indicate how the employer treats first-year nurses, Benner says. Turnovers higher than 20 percent are generally considered high in the industry.

Find Out About Orientation and Preceptor Programs

A preceptor is a teacher and coach who helps nurses become oriented and familiar with a facility’s routines, procedures and people, says Patricia Hooper Kyriakidis, RN, MSN, PhD, a nurse consultant and researcher and president of Practice Solutions, a Hendersonville, Tennessee-based healthcare consultancy. New nurses are more likely to stay if they have an experienced and helpful preceptor. That’s why you should ask, “Will a preceptor be available on my shift after the orientation to answer questions and help with clinical decision making?”

Inquire About Support

Query the nurse manager about the level of clinical, social and emotional support available for new nurses. This support includes having experienced nurses on hand to help debrief a new nurse once he experiences a tragedy at work, such as a death. That debriefing must happen the day the event occurs, not a week later, Kyriakidis says.

Observe the Unit

Simply touring the unit won’t give you a good idea of how people work together, Kyriakidis says. Because it takes a while for people to let their guard down when someone is watching, make sure you observe for a few hours so you get a clearer picture of the unit’s interpersonal dynamics.

Consider Working on a Specialty Unit First

Benner says her research on first-year nursing indicates that it’s actually easier for many new nurses to start on a specialty unit, such as labor and delivery or a highly staffed pediatrics unit, because the patients on those units are more homogenous than those on a medical/surgical unit.

“If you take a position on a general medical/surgical unit, the range of patients is quite broad,” Benner say. “If you work on intensive-care or coronary-care units, you will have more of a controlled patient population.”

Get Your Feet Wet

That’s what first-year nurse Girish Dang, RN, a psychiatric nurse at Melrose-Wakefield Hospital’s inpatient psych unit, did. While he was getting his ADN at North Shore Community College in Massachusetts, Dang worked on the hospital’s psych unit as a psychiatric counselor. He credits that experience with helping him hit the ground running when he began working as a nurse on the unit, because he was already familiar with the culture and knew whom he could lean on for help.

The same can’t be said for all of his nursing school classmates. Dang says he knows of several fellow graduates who, lacking prior experience with their employers and insight about the staff and working environment, left their first nursing jobs within six months.

“In my opinion, 90 percent of the things in the job are learned not in nursing school but in the job itself,” Dang says.