She glanced to either side as she slowly ambled down the hall, her shoes like cement blocks with every step. Her teammates pretended not to notice her as she passed, but she felt their piercing stares on her back. There were no smiles, not one friendly face.
Were these the same nurses with whom she had been orienting for the past few weeks? It was her first shift off of orientation, and she felt indescribably isolated.
Palms sweating, her heart thumped loudly as she approached the patient rooms. An experienced nurse was finishing charting, visibly ready to pounce. The new nurse smiled wanly as she drew near, wanting to give some appearance of confidence. There was only an icy stare in return.
As they looked at the first patients chart, the new nurse quietly asked a question. It was relevant, a point of information, and she thought it sounded reasonable. The hall suddenly reverberated with the veteran nurses piercing voice, loudly chastising her for daring to inquire. The novice nurse could feel her face flush as her eyes welled with tears and she tried to swallow the painful lump growing in her throat.
Many years ago, this new nurse was me. My preceptor had been kind, the staff with whom I worked were friendly, and yet this still occurred on my first day off orientation.
Fast-forward several decades to todays world. Nurses practice in stressful arenas with computerized medical records, faster-paced environments, sicker patients and an increased need for critical thinking skills. Multiple medication loads, high standards for patient satisfaction, constant patient and family needs and requests, and stringent physician demands stretch even the most competent. With patience waning, even outstanding nurses can become easily frustrated and expect trainees should immediately know it all once they end orientation and take on their own assignment.
I remember a nurse, Carly, who had impressed me when I interviewed her in my position as nurse manager. Relating that she loved nursing, she wanted to join a staff where she could use her skills, be appreciated by her patients and just as importantly be part of what she described as a nursing family where she would be valued.
I watched from afar as she began listening to report during her first morning on her own. I was dismayed as I saw her smile lessen, her face become red and the enthusiasm drain from her face. All of my first memories flooded back to me.
Although I got past my first painful experience, I never have forgotten my first introduction to real, live nursing. If all nurses could flash back to their first day alone, taste their raw emotions of enthusiasm mixed with apprehension and carry those memories forward as they work with new nurses, the cycle of compassion which helped us enter nursing to begin with would be completed.
Hospitals should design in-services for veteran nurses to foster empathy, concern and understanding when helping new nurses begin their road to independence. These same in-services can be incorporated at the unit level, where clear managerial expectations are established and all nurses are held accountable for appropriate behaviors and actions.
This approach will increase nurse satisfaction and retention and improve unit teamwork. Unit staff members will feel a sense of pride and commitment to one another while achieving a strong and united work environment.
The opening scene can be rewritten. As the nurse begins his or her journey down the hall, every nurse welcomes him or her. Questions are answered with a smile, help is offered consistently and the novice nurse has the sense of security needed to function as an independent practitioner.
In this way, a pay-it-forward environment and a strong work culture of compassion and support will emerge.