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Reality sets in

We asked the new grads what they wished they had learned more of in nursing school. Most expressed their feelings of inadequacy when it came to clinical skills.

"More clinicals! IV therapy!" one new grad said. "And another thing I have come across that has been something I never got answered in school was what exactly can an LVN/LPN do?"

Another said, "Delegation and prioritizing are skills I think a lot of nursing students lack when we come out of school and then all of a sudden are expected to do it."

Some of the requests seemed specific and simple. "This is kind of dumb, but I wish that they would have taught us how to tie those restraints into the slipknot," one new grad said. "I have come into contact with that so many times, and I still don't think that I have it right. It's the little things that just make life so much easier."

In the first month, much of what we heard from these new grads reflected the natural anxiety that goes along with a first job. "Reality shock ... I thought that I had learned so much in school. The reality is that I will forever be learning!"

Personal growth

Checking in a few months later, we noticed the significance of whether a new grad had a consistent preceptor.

Preceptors clearly made a big difference in how well the new graduates developed confidence in their abilities-even in the first few months. New graduates who had preceptors and whose preceptors were consistent seemed to gain confidence more quickly and feel better about themselves as nurses.

Too often, however, preceptors were pulled to other assignments and the new graduates were left either without a preceptor or having to switch to a new preceptor. One participant said, "Sometimes your regular preceptor would not be scheduled on a day you were. This was the least helpful when it came to learning because all RNs have a different style in how they carry out the day's assignments. Whenever I was with a new preceptor, it was almost like starting all over again."

Anxiety levels fluctuated. In these first few months, our participants were still coming to terms with the fact that they no longer were students, but actual nurses.

This sentiment was expressed best by one grad who said, "This is such a strange feeling. I go from thinking, 'Yeah, I'm a registered nurse-not a student, grad nurse, intern, etc. A full-fledged registered nurse. I've got it going on.' "

She went on to say, realizing the other side of her new feelings of confidence was a test in humility, "Then last night, the charge nurse and I go into a patient's room and his heart rate is 40 and dropping, not breathing and the most amazing color of blue I have ever seen. She runs out of the room shouting, 'Call a code, call a code.' And I'm standing there like an idiot going, 'What do I do, what do I do?'

"I thought school was humbling enough, but apparently, I still need lots of humbling. I'm just taking it one day at a time."

Many family adjustments had to be made, too, once the new nurses made the transition from student to full-time nurse.

A lot of the participants were open in telling us what it was like to experience these adjustments.

One nurse said, "The past few months have been a period of a lot of personal growth. Since the end of school, I've moved out of my parents' house and have been introduced into the real world where working full time, bills and independence have come to life. I have had to make adjustments over the past few months-coming to terms with not having to go back to school at the end of summer, waking up at 5:30 a.m. to go to work four days a week and not seeing my best friends almost every day like I was able to when I was in school.