I’ve been away from this blog for quite awhile spending my days either orienting to my new job as a nurse or recovering from it. We (as in all new grads at my job) were warned there were three phases to orientation: Doing, Being, and Knowing. This is called the Transition Theory. I won’t tell you what I call it at the moment seeing as I am currently in phase II.
Phase I aka Doing is the time period where a new nurse graduate has just started a new job and is learning the ropes. For me it was all about taking the information from nursing school and readjusting it to reality. Nursing school is about the perfect world, but we practice nursing in the real one. It would be wonderful to take the time to listen to a patient’s entire life story, but his next door neighbor keeps decorating the bed, floor and walls with projectile vomit. It is also about building skills. Learning how to do something on a mannequin is dramatically different than doing it on a screaming, fighting, cursing patient. This phase lasts about 3-4 months. I really enjoyed this phase. I had a preceptor who backed me up. I could ask all the dumb questions I wanted and no one looked at me as if I needed to go back to school. I was sad, but ready (ha!) when my preceptorship ended.
Phase II aka Being is where a new graduate nurse begins to have a growing awareness of what nursing actually is. The preceptor signs off and the full weight of responsibility descends. Feelings of incompetence, exhaustion, inadequacy, frustration, and a whole host of doubts creep in and take residence. According to research this phase is during the 5th to 7th months of the new job. I am coming up on month #4, so I am early to the show. I have to say I do not like this phase, not at all. I have had two real confidence-killers. In one I transferred my patient to a medical-surgical floor only to have the patient come back to the step-down unit the next morning. In the other an RRT (rapid response team) was initiated for my patient while I was at lunch and the patient had to be intubated then sent to critical care. Both times I was told I had done everything right. I cannot let it go. My mind circles those two incidents repeatedly trying to see what I missed, what I could have done better, how did I fail. It does not help that there is a culture of “eating their young” in nursing. My unit is mostly good about this. I have had a lot of support from my co-workers. However I have found that even the slightest perception of doubt in a co-worker is enough to have me scrutinizing everything I said or did that might have caused it. This is a mentally exhausting phase to be in and I will be so glad when it is over.
Phase III aka Knowing happens around 10-12 months and is when a new graduate feels more comfortably in their role, stops being a “new grad” and has gained confidence in their ability to care for patients effectively.
Here’s to Knowing. May she step to the plate faster than predicted!