Chapter 1 Your New Career It's your first day as a nurse and, boy, are you nervous. Did you make the right decision? Is this the best career for you? Can you handle the responsibility? The nervousness, anxiety, and indecision are normal. When the reality of your chosen profession becomes evident, it can be overwhelming. But never lose sight of the reason you decided to enter this glorious profession--to help others, have a positive impact, and make the world a better place to be. That's what it's all about. Most of us start out feeling scared, nervous, and perhaps even inadequate. Remember that after the end of your first day on the new job, you'll be more experienced than you were that morning. After each day, you will be further along than you were the day before. Before you know it, days will turn into weeks, weeks into months, and finally you'll find yourself with a full year of experience under your belt! It's important, in this early phase of your career, to set small, realistic goals for yourself. Set an initial goal to get through orientation. Then set successive goals: to get through your first three months, six months, one year. Most experienced nurses agree that it takes about a year before you feel comfortable with most common situations. It will probably take two years to be completely comfortable with all situations. So be patient and just persevere. In many ways, your education is just beginning. I used to say, jokingly, that I never learned anything until I got out of nursing school. Although that isn't completely accurate, once I was out of student mode and no longer in the safe confines of my instructor's wing, finally working on my own as a licensed nurse, it sometimes felt as if I were starting from scratch. I suddenly realized the responsibility I had. I wondered if I could meet everyone's expectations. Nursing in North America While there are some minor differences, such as in credentials and terminology, nursing in the United States and nursing in Canada are very similar. The biggest difference is that Canadian nurses work within a national healthcare system and nurses in the United States work in a largely private system. This does not, however, translate into a significant difference in day-to-day practice. Nurses in the United States are licensed by the state(s) in which they practice, and Canadian nurses are likewise licensed by the appropriate province or territory. Nurses in the United States who are involved in clinical practice should obtain their own liability insurance in addition to the coverage they may or may not have from their employer. With the exception of advanced practice nurses, this is a much less common practice in Canada, where the legal climate is very different. In Canada, employers often cover nurses for liability, though most have additional coverage through their provincial and national nursing associations. However, the Canadian legal climate is changing. More and more nurses are being named in lawsuits. Potential litigation is a concern for every nurse to take seriously. Both Canada and the United States utilize nurse practitioners (NPs) and clinical nurse specialists (CNSs). Both countries also utilize practical nurses, although their titles may vary depending on which part of the continent they are practicing. You will find licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) in the United States. In Canada, there are registered practical nurses (RPNs), LPNs, as well as several other titles, though the trend is to use only the title LPN across the country. When nurses are licensed in Canadian provinces other than Quebec and Ontario, where membership is left to individual choice, they automatically become members of their provincial and national nurses association, the Canadian Nurses Association (CNA). In the United States, professional association memberships are completely up to each nurse. Despite such minor differences, nurses in Canada and the United States have the same challenges, rewards, goals, frustrations, and joys. I also remember how I would gaze at more experienced nurses with awe. They seemed so confident, so in control, so calm in a crisis, and so all-knowing. I couldn't imagine that I would ever reach that level of practice. But an amazing thing happened along the way. Not only did I continue to learn and grow in my new career, but here I am, many years later, loving every minute of this wonderful profession and giving advice to other nurses. You, too, will someday look back and see how far you have come. Externship Versus Internship An externship differs from an internship. While an externship or "summer nursing associate program" is usually available to student nurses, an internship or nurse residency program is usually offered to new RNs as intensified training during their first year of practice and/or in preparation for working in specialty areas such as the intensive care unit (ICU), the operating room (OR), and labor and delivery (L&D). Many externs continue to practice part time at that facility until they graduate. Not only does an externship give them significant clinical and leadership skills, but the experience looks great on their résumé and gives them a foot in the door for possible hire after graduation. Internships for new RNs vary in type and scope and are different from general employee orientation. Some have been developed by the individual hospital or health system, and others are part of a nationally developed curriculum. Characteristics of internship/residency programs may include the following: *Classroom and skills lab instruction *Online learning opportunities *Unit-based clinical experience with preceptor *Mentors *Support/self-care groups *"Looping" to other related units in the facility It is in your best interest to find the longest and most comprehensive new graduate orientation/internship program available. A one-year program is ideal and very desirable. However, not every facility offers this. In fact, you've already come a long way. Phase one of your nursing education and training was your formal schooling. Consider your first position as a nurse to be phase two. Don't be too hard on yourself in the beginning. You're not expected to know everything as a newly licensed nurse. In fact, no one--not even the most experienced nurse, physician, or other practitioner--knows everything. For each of us, myself included, learning is an ongoing process. If you're not learning, you're not growing. And if you're not growing, you're stagnating. So now it is time to begin phase two of your learning process: your first job. Where do you start? What do you need to know? The key to getting the job you want is to have a plan, prepare, and dive in! Excerpted from Your First Year As a Nurse, Revised Third Edition: Making the Transition from Total Novice to Successful Professional by Donna Cardillo All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.