So, it’s here, you’re doing it, your last placement as a student. I had worried a lot beforehand that I needed to know everything by the end of this placement, and that I would be ‘good enough’, not only for the team, but for my own expectations.
But that first day in blues came around, and amongst the high fives on the way in (after the nearly vomiting with nerves in the car park beforehand!), I remember saying to one of the nurses, who stopped to give me a hug and ask how I was feeling. I confided “I feel a bit like I’m walking around pretending I know exactly what I’m doing”. And her response? Horror? Shock? Escorting me off the ward? No, she just looked at me and said:
“Yeah, what were you expecting? That you’d wake up this morning knowing everything you didn’t know yesterday? Welcome to nursing. I still have days where I don’t know the answers. Every day you’ll learn something new. You know more than you think you do, and you’re doing just fine”.
It is nothing new, and its widely documented that the transition period from student to registered nurse faces NQN’s with many challenges (Duchscher et al. 2009). However confident and ready you feel at the end of your management, that first week in blues feels completely alien. It’s the mix of changes in priorities, schedules and values along with getting to grips with different staff attitudes to NQN’s, combined with not only learning but acquiring the evidence behind new skills and practices (D’Ambra & Andrews, 2008; Rush et al. 2014).
I don’t think I realised during my time as a student just how protected I was. It’s like a tightrope walker, you’re so busy looking ahead, desperate to reach the destination, that you don’t look down and notice the safety net. Until suddenly, you’re in blue, with patients to look after, you’re acutely aware of its absence. But, three months in, I’m starting to realise that instead of looking down, if you look around, you’re not up there alone, there’s a whole team of you, all willing each other on, supporting each other, and keeping each other up.
Although prescribed by the Nursing and Midwifery Council (2018), the level of support each nurse gets during their preceptorship seems to be dependent on where you choose your first job. This would be my advice about first jobs. Obviously, it has to be somewhere you enjoy and in an area you’re interested in. But go where there’s a strong team ethic. Where people work together and where you’ll be supported. Ask what the preceptorship looks like. How much support will you get, who can you go to. We’ve had lots and lots of extra training since qualifying, learning skills relevant to the job. The preceptorship framework includes regular meetings, feedback, encourages regular reflections and a large number of competencies to work through. All of this helps you to feel more secure.
Although many theories exist surrounding the transition period, all would agree higher staff attrition rates occur when the new registrants wellbeing is looked at, alongside the learning of new responsibilities and gaining the increased confidence needed in both learning and performing new skill sets (Duchscher, 2008; Martin & Wilson, 2011). This is further discussed by Rush et al. (2013) who added by starting these discussions during the student period – feelings of shock and abandonment can be decreased.
Cole-King (2018), Peterson et al. (2008) and Wilson & French (2001) have offered many definitions of the term ‘emotional resilience’ – combining the need for, among others, the physical, emotional and psychological resources to cope; to be flexible enough to thrive in the face of adversity. Connor and Davidson (2007) offer characteristics and behaviours of ‘resilience’ – including prioritisation and time management, continuous self-development and pressure management techniques. Wouldn’t it be ideal if we could combine these into a standardised preceptorship programme, beginning during university, to equip new registrants with the ability to not only survive, but thrive in a long career in nursing. With tools such as simulation and scenario exercises, true to practising life as NQN; access to both closed and open forums for NQN’s to openly reflect, share and learn from experiences; an extensive list of available CPD courses relevant to each field, as well as extended access to university VLE’s which, arguably would be most useful at this time, and access to a link tutor contact for those first few weeks, someone who, while impartial to the workplace, has been in the same situation and can perhaps offer support.
I’m really enjoying NQ life, it’s harder than I thought it would be. I’ve laughed, and I’ve cried. Not cried because I wasn’t enjoying it, but some of the things you see, and some of the conversations you have, are, quite simply, overwhelming. But it’s all about support and learning to trust your own knowledge and recognising the areas you need to gain more knowledge on. It’s a new confidence you learn, being able to confidently ask for help without feeling incompetent. Not comparing yourself to others, for their journey is their own, their experiences different, and it takes a variety of people to make a team – this part seems to be all about working out where you fit in. Like a driving test – you’ve passed it, your competent, but now you’ve a car of your own and you need to figure out what kind of driver / nurse you are.
It’s easy to be negative, especially when under great pressure. It’s even easier to feel alone when you’re struggling, and to see asking for help as a weakness. But my time as a student, and in fact more so my time as a newly qualified nurse, has showed me you’re only as strong as the team around you.
And a great team is full of people who lead in a range of different areas – those who innovate; those who organise and co-ordinate work efforts; those who encourage trust and co-operation; those who litigate; those who act and both inspire and engage others, and those who support, develop and empower people.
All the research into leadership tells us great patient care comes when nurses feel encouraged and supported by their leaders, and in turn where the work climate is positive and supportive , and where people are given opportunities to participate in decision making, they report higher levels of organisational belonging and job performance increases as a result.
In studies where all nurses are encouraged to be involved in quality improvement -higher levels of empowerment and performance shine through again. Put simply – where all members of a team are supported and have a voice – they feel involved and have the emotional capacity to care for others.
Personally, perhaps controversially, I think the capacity to lead is inside everyone, it only shows in different ways. The temptation at times like these, when everybody in every role within healthcare is stretched and pushed to their limits, is to look for some inspirational celebrity or historical figure, someone who’s achieved greatness despite incredible hardships and measure yourself up against them.
To be inspirational means to make you feel full of hope or encouraged. And these people are all around us. It could be your favourite author who uses words like a paintbrush, painting emotions and feelings so real you can reach out and touch them and feel strengthened by their proximity. Or it could be a friend, who’s going through the most awful time, struggling with the worst kinds of crippling anxiety and consuming depression, but still manages to get up every day and just carry on. It could be a lecturer who invokes such inspiration it’s hard not to be swept along and strive to be as passionate, empathetic and hardworking. And it can be your work colleagues who cheer you up, cheer you on and keep each other going.
In a culture where we’ve grown to measure success by status, perhaps we should instead measure success by innovation, and the effects of such on other people. By innovation, I’m not exclusively talking about those bringing about huge changes, but also those whose actions and ideas inspire actions in other people. The carer who sits with a patient with dementia who is unable to communicate their wishes in the way they used to and is afraid – and develops a way to ease this confusion during their shift. The lecturer who changes and develops modules to suit the learning and perhaps family needs of their students. The practitioner who helps develop new guidelines and courses to enhance future patient safety. Work mates who take that 20 seconds to ask “Are you ok? How’s your day going? Let me know if you need anything”
These are all, surely, equally both successful and fundamental to any great team, and furthermore, surely all equal leaders?
Being kind, mindful of the stresses other people may be going through, being respectful and compassionate. They are none of these passive states. They each require action, and equally as important – reflection. Measuring the success of an individual not merely by results, but the growth and development of the actions which preceded it. The end result may be fabulous, but I’m a great believer in celebrating the whole team behind it. Instead of searching for the negative, which sadly our media seems so intent on – acknowledge and celebrate all the positives and draw from them. Shout from the rooftops about them. Where negative experiences happen, share them openly and frankly, reflect on them and then keep on moving forwards.
Don’t Just be a nurse, don’t just be a leader – be a cheerleader. Tell the world about all the incredible people who make up your team, who make your day easier. Tell the world and celebrate the best kind of team – nurses, doctors, midwives, healthcare support workers, porters, domestics, ward clerks and everyone else who, however bleak the outlook, always pull together to look after others.