So, it has been just over a month since I qualified as a registered nursing associate. I thought I would reflect back over this period of time.
Perceptions And Expectations
I am fortunate in that the senior staff and my permanent colleagues have been incredibly supportive of me during the change from trainee to registered nursing associate. The level of responsibility has increased over the weeks but has been staggered in a way that has allowed myself to become accustomed to my new role with many of the tasks taken on by more experienced colleagues. For that I am very grateful to my team.
Patients and relatives had no idea I was newly qualified and in those first few days it was so overwhelming to be the person who needed to have all the answers. Fast forward a month and I have developed a few strategies and skills.
Keeping updated with what other members of the multidisciplinary team have done or are planning to do is essential. I often overlooked this at the start but I try to check progress notes as much as possible. Being familiar with the typical medications that are used in my area and any reasons why a doctor would have started or stopped a particular medication is essential in being able to answer questions confidently. Staying ahead on discharge planning or further treatment planned for the patient is also another essential task – especially in helping families prepare for discharge and to reassure patients about their care. I am not there yet – but I do feel that I am making progress.
Doubts And Fears
My biggest doubt so far is that I am simply not good enough for my role. Speaking with friends who are newly qualified and other colleagues I know that I am not alone in feeling this way. However, I know others who are so confident in their abilities and just seem to be on top of everything. I worry that I will never be able to manage my workload, keep on top of tasks and complete them in good time, and just simply feel that I am doing a good job with the minimum of support. I did not expect to still feel this way after a month.
Good Days And Bad Days
Some shifts have gone incredibly well. On those days everything just seemed to fall into place. Maybe it was the team I was working with, the patients in my care, no discharges or admissions, or just plain luck! On days like that I left work feeling positive and ready for the next shift. I love those sort of days when I can go home and not spend the rest of the night ruminating over mistakes or things I could have done better.
In truth, the good days have been outnumbered by the bad. There are days when I just don’t feel like I am good enough for my role. These days are nothing but stress from start to finish and I am constantly feeling like I am running just to fall behind. I look at other registered staff, even ones that are new to their role, and they just seem to have everything together.
Responsibilities And Accountability
I work under the direction of a registered nurse, which in my area is the nurse in charge. But I am also registered and accountable for my own actions, inactions, omissions, and mistakes. This has been quite a shock to the system from being a person who always needed to “go and get the nurse”. I have always worked to the best of my abilities and in a professional manner – no matter what role I was in. However, there is something different about having a PIN to protect and a professional body to be accountable to. Having the best interests of my patients always came naturally to me – but also having the best interest of my own registration is something new – and can be quite terrifying at times!
Filtering Out The Noise
Something that has really surprised me is the amount of information that is brought to me that really doesn’t need my attention. I won’t go into details but it does feel that the different shade of blue uniform, and especially the red “do not disturb” drugs tabard has made me a particular target for irrelevant information! One thing that I have found I have improved upon is the ability to let this noise wash over me during medication rounds. If I am told that a patients blood pressure has dropped by 40 then I am ready for action – if I am told that the blood glucose machine needs more test strips then I just let that go over my head!
Constant Reflection
When I first began my training, I thought reflection was an overrated and unnecessary process. Over the past two years, I came to really value structured reflection and how it can be used to learn from experiences – especially difficult experiences. I have found that structured reflection is helpful in stopping myself from damaging rumination and overthinking – which is something I find easy to do!
Giving Up
Some days I have just wanted to give up. I have wanted to return to my HCA role. It was a role that I really loved – there was a lot of patient interaction and minimal documentation. Registered life is all about documentation – hours and hours of documenting. Physically it has been much easier, but mentally it has been exhausting over the first few weeks. Time pressures are intense – there are always multiple things that need to be done at the same time and learning to prioritise has been essential. I’m not there yet but I do feel that I have made progress.
Guilt
As a former healthcare assistant, I know how appreciative I was if the registered nurse or nursing associate I was working with was able to help with personal care – especially days when our team was short on staff. As a nursing associate – I am intently aware of the workload of my colleagues and the physical nature of their role. I know at this moment I am slow – double and triple checking everything and often needed reassurance I am doing something right. Only a couple of days have I actually managed to complete my morning tasks and be able to assist the team. I feel very guilty about this. I assist my patients with repositioning and transfers to the toilet when I can but I know that I am at the computer or on a phone call a lot of the time. I remember when I was a HCA and some of my colleagues would say that the nurse is being lazy for always being on the computer. I would hate to think that I am thought of as being lazy.
Going Forward
So this is the end of my first blog post. I will keep it updated on my progression and I will make sure to post about the positives as well as the negatives.
Thanks for reading, Beth.
