21 job survival skills they didn’t teach you in nursing school

So you finally finished nursing school and you’re ready to launch your new career. Yes, it’s an exciting time, but keep in mind, you may need to adjust your expectations. Many nurses agree that their first year as a nurse was one of the most difficult and challenging times of their career. While nursing school provides you with a good foundation, it just can’t fully prepare you for the day-to-day rigors of being a nurse. Several Nebraska Medicine nurses share their thoughts on some of the things they don’t tell you about in nursing school. 

1. It’s a juggling act
“I knew I’d be juggling a lot,” says Tiffany Whitney, BSN, RN-BC, nurse supervisor for the  Medical-Surgical Unit at Bellevue Medical Center. “But I was surprised at how much I had to balance once I started full time as a nurse. It can be intimidating at first. But eventually you’ll figure out how to prioritize and get your job done.” 

2. You might be sleep deprived
“I found shift work especially difficult to adjust to,” says Michelle Schulte, MSN, RN-BC, ambulatory supervisor for the Dermatology clinic. “They don’t teach you about how to adjust to new sleep schedules and working nights. You may find yourself very exhausted at times.”

3. You may have to work holidays and weekends
When you take a job in the inpatient setting, everyone has to work weekends and holidays. “The first holiday I had to work was Christmas and it was devastating,” says Schulte. “It was Christmas Eve and we were in the middle of a snowstorm. My shift was over, and I was anxious to see my family and celebrate that evening. But then I was told that if I didn’t think I could make it back the next day, I should plan to spend the night at the hospital. I was so disappointed. It would have been the first Christmas I’d miss in 23 years. Fortunately, my parents were able to come pick me up and took me back to work the next day.” 

4. How to cope with patients with mental illness
In nursing school, your exposure to psychiatric patients will likely be minimal. Schulte, who worked in a Medical-Surgical Unit, quickly found that many patients with chronic illnesses also have depression and anxiety. And then there was homelessness and the lack of mental health resources available. “I had to quickly learn how to have thicker skin,” Schulte says. “It’s rewarding to see someone with a physical condition get better. But you don’t see those types of big changes in people with mental health issues. It’s harder to find that silver lining.” 

5. Detecting changes in your patients’ status may be more subtle than you think
“In nursing school, you learn about changes in vital signs that can indicate your patient is going downhill,” says Amy Moore, BSN RN, clinical nurse in Neurology. “So you think it’s going to be obvious, but that’s not always the case. In most cases, I’ve found that a patient’s status usually occurs in small, gradual changes. They might become more lethargic throughout the day or their oxygen intake or blood pressure may increase slightly. I’ve learned that you really need to be in tune to these small changes and not dismiss them.”

6. You’ll likely make mistakes
“You will make some really stupid mistakes, but so will everyone else,” says Emma Warner, BSN, clinical nurse in the Intensive Care Unit (ICU). “The important thing is that you learn from it. Even the expert nurses learn something new every day.”

7. You just might enjoy it! 
“No one tells you how much fun it can be,” says Schulte.  “Nursing school is so serious but being a nurse is actually fun and enjoyable. Your colleagues become your family and some of the most valuable people in your life.”

Tips to manage your first year more smoothly

While your first year of nursing can be challenging as you learn how to multitask and juggle multiple responsibilities, our seasoned nurses offer these tips to help you manage your first year more smoothly.

8. Prioritize
“You will have orders coming to you from all different directions,” says Whitney, “so you will need to use your critical thinking skills and prioritize the most important tasks first.” 
Take good notes and try to focus on completing one task at a time before you jump to something new.

9. Keep learning
“Take any or all classes that are available to you whether they are continuing education, learning lunches or online instructional seminars,” Whitney says. “Depending on the area you are working, there will likely be classes offered that can help you perform your tasks better and more efficiently. I took anything possible, including how to run a ventilator, medication titration, etc. These helped me immensely and definitely helped shaped my abilities as a nurse.” 

10. Partner with a mentor
Every nurse should have a good mentor,” says Mary Clarke, RN, PRN nurse. “Once you’re done with orientation, you are basically on your own. Find someone who will be your teacher, whom you feel comfortable asking questions and can confide in throughout your early years. It will make a world of difference.”

11. Ask questions
Many new nurses are afraid to ask questions. “It’s okay to ask questions,” says Clarke. “Every nurse knows what it’s like to start your first year on the job.”

Derek McCroy, MHA, BSN, RN, ambulatory supervisor for Pre-surgical Screening and Surgery Scheduling, clinic nurse in the Department of Orthopaedic Surgery, couldn’t agree more. “During my first year, I remember thinking, ‘I don't want to be the new nurse that asks all the questions.’ But then I thought, ‘I also don’t want to be the nurse that makes a mistake and possibly causes harm to someone.’ So ask, ask away! You won't learn everything in nursing school, so there will be things you are unsure about. Asking questions will build your knowledge bank and help you to become a more confident nurse.” 

Warner remembers being pleasantly surprised to find that “doctors become your friends and look to you for advice just like we look to them. We’re all in this together!”

12. Take notes
“I had a notebook that was dedicated to everything I was learning as a nurse,” recalls Whitney. 
“You’re learning a lot your first year, so this was very useful when I needed to refresh myself on certain skills or protocols.” 

13. Make lists
A nurse’s job is never done. “But at some point, you need to go home,” says Katie Donner, BSN, RN, a case management nurse in Plastic and Reconstruction. “I recommend making checklists and setting deadlines. This always gives me a sense of accomplishment and helps me feel confident that I’ve gotten everything done that has to be done, so I feel more comfortable about going home at the end of the day.”

14. Try new things
“Don’t be afraid to work in new areas or work in roles that may help lead to the end goal,” says Whitney. “You have to get your feet wet and every experience is valuable in helping you become a better nurse and determine what you are good at, and what you really enjoy.”

"Floating is a great way to try new areas and learn new skills," adds Schulte. "Nursing units like a Medical-Surgical Unit or a step-down unit will also expose you to a lot of different specialties and will help you hone your critical thinking skills." 

15. Give it time
"When you start working in a new area, everything is going to naturally feel foreign," says Amber Seidl, BSN, RN, case manager for Plastic and Reconstructive Surgery. "Give yourself at least six months to adjust before you decide to make a change."

16. Smile
Sometimes hospitals can be a very serious place. “But don't be afraid to smile,” advises McCroy. “A simple smile can put someone at ease, including both your patients and coworkers.” You might be surprised at how quickly it can change your attitude and disposition. 

17. Get involved
Join committees, participate in meetings and leadership opportunities. “Forums like shared governance gives you the opportunity to do things that are can really make a difference in your profession,” says Schulte. “Spawning a new idea that ends up being implemented and improving your practice can be extremely gratifying.” 

18. Embrace change
“Expect to be uncomfortable,” says Clarke. “The way it is now is not the way it’s going to be in a year or two down the road,” says Clarke. “Technology is changing things so rapidly. Embrace it, expect it to change and grow with the changes. Every generation seems to introduce something completely new to the nursing practice.” 

19. Start saving early on
“It’s exciting to get your first paycheck and even more exhilarating when you get your first few raises,” says Clarke. “It’s tempting to spend it right away, but instead, think about opening an IRA and start putting away money for retirement when you are young and you will be amazed at how fast it will grow. If you have it taken directly out of your paycheck, you’ll never miss it but you will appreciate it later down the road!”

20. Do it now
One thing that Clarke learned as she navigated her nursing career, “if you’re curious, just do it! Life gets more complicated the longer you are out of school. If you want to advance your degree, work as a travel nurse or whatever that dream is, reach out and grab it before it’s too late. Step out of your comfort zone and push yourself. You never know where it will take you. I always wanted to work in the emergency room in Chicago but never did it when I was young, so I missed my opportunity.”

21. Take care of yourself
“You’re not good to anyone else if your own bucket is empty,” says Clarke. “Get a hobby, exercise, spend time with friends and family. You will be a happier nurse when you’ve given yourself a little TLC.”