How to Thrive as a Newly Registered Nurse, second edition

By Carol Forde-Johnston

How to Thrive as a Newly Registered Nurse provides a structured programme of support for nursing students and newly registered nurses during their first year of registration. Fully updated and packed with practical examples, tips and advice, and featuring vignettes from recently registered nurses, this book will help you to:

• Choose your first nursing post and secure the job you really want
• Structure your learning and development in the early stages of your career
• Work in a team, prioritise your care-giving and delegate to others
• Understand safe staffing, patient acuity and dependency tools, care planning, and risk assessment tools
• Learn how to escalate concerns and report incidents
• Understand mental capacity assessment to guide your decisions in practice
• Understand how to access research opportunities and funding for education
• Plan your future professional development and career progression.

Here’s what some reviewers said:
“…This book reads like you’ve got the loveliest mentor you’ve ever had holding your hand through the transition from student nurse to registered nurse. Just reading it made me feel calmer and better prepared about my imminent start. In my opinion Carol Forde-Johnston’s book is the best transition book I’ve read.”
“This book is well written and very helpful. I recommend it to all our preceptees and they are all grateful to the author for such a wonderful book. One of my preceptees called it a ‘manual for all new nurses’.”
“I noticed that it answered many of the questions I was always embarrassed to ask as I thought I should have already known those things.”

Drawing on over 34 years’ experience supporting students and newly registered nurses, Carol Forde-Johnston has written an accessible and practical book that aims to respond to the questions and concerns that her students and NRNs frequently raise – and to help you thrive as a newly registered nurse.

• Language: English
• Publisher: Lantern Publishing
• Release date: Sep 11, 2023
• ISBN: 9781914962110

Carol Forde-Johnston

Carol Forde-Johnston (RGN, BSc (Hons), PGDip, RNT and MSc) is a Divisional Recruitment and Retention Lead in the Oxford University Hospitals NHS Foundation Trust. Her role involves leading recruitment and retention initiatives and providing structured career advice to all levels of staff, with a particular focus on supporting newly qualified nurses and international nurses. Carol qualified as a registered nurse in 1989 at Coventry School of Nursing and went on to specialise in neurosciences. She worked for 20 years as a lecturer practitioner, a joint appointment between Oxford Brookes University and the local NHS hospital Trust, integrating research, education and clinical practice, and leading a third year nursing degree module and supporting nursing apprenticeships. Carol has published numerous articles relating to education and practice development in nursing and medical journals. Carol has also been involved in patient improvement initiatives and collaborated with Oxford University on a staff-led quality improvement project to prevent inpatient hospital falls. She passionate about developing and supporting staff and student nurses to improve their confidence and fulfil their future aspirations and is currently studying for a PhD in nursing.

Book preview

CHAPTER 1

CHOOSING AND SECURING YOUR FIRST NURSING POST

I wish I had known that choosing the right first job, in an area with good clinical education and support, is so important. Fortunately I chose wisely! Even though I worked on a busy ward for my first year qualified, I had clinical educators to guide my learning and they made such a difference.

3 years post-registered children’s nurse

I was not appointed to the post I really wanted and was devastated. I worked in a GP practice as a second year student and the staff all wanted me to come back once I had completed my training, so I just thought the job would be mine. Little did I know how popular the job would be, as two students from my cohort went for the same job and one of them got the post, as she interviewed much better than me. I was such an idiot for not prepping for that interview, but I picked myself up and decided to go for it again in a few years’ time. I have another interview next week for a band 6 post and I have put hours into prepping for it this time.

2 years registered as ward staff nurse and 1 year as a community staff nurse, his current post

As a Recruitment and Retention Nurse Lead working in a busy UK NHS trust, I offer advice every year to numerous registered nurses, student nurses, nursing associates and support workers to help them choose the right job and secure the post in the area they want. I shortlist and interview for newly registered roles across my hospital division too, and the two questions I am most frequently asked by final year student nurses about to register are: "How do I choose my first post? and Have you any interview tips to help me get the job I want?" This chapter will try to answer these two key questions.

With preparation and by following the guidance and the interview tips in this chapter, you can achieve your goals and realise your aspirations!

1.1 HOW TO CHOOSE YOUR FIRST POST

The importance of your first post

The importance of choosing the right first nursing job, that offers support and opportunities to develop your future career, cannot be underestimated. I vividly remember my first post in the 1980s working on a busy neurosurgical unit, where patients’ beds were lined up, side by side, in a large open Nightingale ward that lacked privacy and had only a couple of side rooms. I remember rows of patients with full head shaves, as opposed to the partial head shave used prior to brain surgery today. I felt anxious when the charge nurse snapped: "Staff nurse Kirrane, you won’t get much done standing there!" I remember feeling completely out of my depth and just wanting to turn around and go back to my cosy room in the nurses’ home (all hospitals had very cheap nurses’ accommodation back then). You were never called by your first name in the 1980s on UK hospital wards, and my students laugh when I tell them I had to stand to attention when my matron entered the vicinity. I remember odd smells, a strange mixture of smoke and antiseptic, from plumes of cigarette smoke enveloping the night nurse who was handing over to the morning staff while having the usual ‘end of shift fag’ in the staff room. It all sounds alien today.

Although you are working in a different era, you will also have many successes and challenges during your first nursing post. You may make mistakes, small and large, as everyone does during their first year registered. The importance of having a collaborative team to support you and good role models to nurture your development in your first post cannot be overstated.

I had an excellent senior staff nurse as a role model in my first post who taught me always to introduce myself to every patient, face to face, when I started my shift. I remember her explaining that if I focused on writing a care plan during the first hour of my shift, and not meeting patients, it would be very difficult to recognise a confused patient who might wander. I regularly used this simple advice given to me during my first year registered caring for neurologically impaired patients, who often wandered around wards that had no security locks. On every shift that I have completed since, I always introduce myself to patients at the start of a shift and inform them when I am leaving.

Practical instruction that works, and which comes from a good nursing role model, never leaves you. When supporting newly registered nurses caring for similar patients, I impart the same advice I was given 30 years ago. I also suggest that they ask relatives for permission to have a photo of the patient by their bedside, check local policies for caring for a confused patient who may wander, and discuss the ethics related to using an electronic ‘wander guard’ armband, along with the issues around consent and ‘deprivation of liberty’ or Liberty Protection Safeguards (LPS) that may be relevant to individual cases. Nursing care and your professional evidence base will always move forward and change with the times. You too will build on key advice given to you during your first year registered as you progress through your nursing career.

The moral of the story and the point of my reminiscing:

Always take time and do your homework before choosing your first post. Check that the role will offer you a good standard of clinical education, a structured preceptorship programme and supportive role models to develop your skills. This will give you the best possible start to your future nursing career.

Nursing placements during your training

The way nurse training placements are set up, in busy hospital and community settings, with practice supervisors maintaining their normal caseloads, can make it difficult for newly registered nurses to know exactly where to apply when they are near to registering. Some students experience a range of specialisms during their placements, such as surgery, medicine, outpatients, community, emergency care, rehabilitation, intensive care, theatres and end of life. They may know exactly which area they wish to pursue on registration, whereas other students are unsure.

There is no need to worry just because a fellow student knows exactly which area they wish to start their career in and you don’t. If you are uncertain about where to specialise, it may be helpful to structure your first post as a rotation post. Usually rotations are set up between two or three areas, and you spend 6 to 9 months in each area, although increasingly, health service employers are offering longer bespoke rotations, e.g. two areas over two years. A rotation does not suit all nurses as they can feel unsettled moving between areas. However, some new starters find rotations invaluable to help them decide which career pathway would be best for them in the long term.

Most UK health care employers realise that a newly registered nurse is a valuable resource who is difficult to recruit and retain. You only have to scan the numerous newly registered nursing jobs advertised across the UK to see that it is your market and to your advantage. You should not demand in an interview that you must have a rotation, of course, but do not be afraid to ask for what you feel will develop your career to meet your needs, as well as the employer’s.

Where to look for nursing jobs

When you decide to look for your first nursing post, there are a variety of places to scan for jobs. UK NHS employers advertise nursing jobs on national online recruitment sites aimed at health service personnel, such as ‘NHS Jobs’ and ‘NHS Scotland Recruitment’. Jobs may also be found on other national online recruitment sites such as ‘indeed.co.uk’. However, it tends to be the private sector that uses these more generic recruitment sites. Health service employers also advertise in popular national nursing journals, local job centres and newspapers, or on noticeboards within their own institutions. In addition, the Royal College of Nursing (RCN) holds a number of national recruitment fairs across the UK for employers to market their jobs to applicants, and employers may also host their own local recruitment events. Some employers also offer online virtual recruitment events that may be recorded, to support people who cannot travel or have difficulties attending in person on the day.

What do you need to decide before you apply for your first post?

Answering the questions in Box 1.1 may help you decide which post to apply for.

Further guidance is presented in Table 1.1, related to the questions in Box 1.1, to aid your decision-making.

The importance of an informal visit

The best way to establish whether a practice setting and the local team are going to support your individual needs is to arrange an informal visit. There is no standard practice for arranging an informal visit. You would usually start by contacting the nurse manager or sister / charge nurse (CN) by email or telephone, to secure an appropriate time. Remember that senior nurses need to prioritise the delivery of their services and you may not receive a response from a senior nurse for a few weeks if they are busy. It is advisable to include a deputy, team leader or practice educator in your email or telephone request, to increase your chance of an early response.

Box 1.1 Questions to help you choose where to apply for your first post

Do I know exactly where I want to work? (e.g. I enjoyed my placement so much as a student that I want to work in this area for the duration of my career)

Do I have to return home, or relocate, due to a partner or finances?

Do I have no idea where I want to work, but I know that I prefer a particular type of nursing? (e.g. surgery, medicine, rehab, intensive care or community health promotion)

Do I already know which role I want in the future and am I ambitious to secure that post as soon as possible? (e.g. specialist nurse, advanced nurse practitioner, nurse educator, research nurse, GP nurse, nurse consultant or alcohol advisor)

Do I have no idea where I want to work? (e.g. my placement experiences were too narrow or I cannot choose between a few interesting areas as they were all good)

During an informal visit you can acquire a mass of information, and your observations and conversations with staff currently in post can greatly influence your decision on whether to apply or not. If you choose to apply, you can also use key information obtained during your visit to inform your answers at interview, e.g. the key professionals and services that support the local area, the key priorities for nursing care required for patients in the related field or the nursing delivery system used.

I am surprised every year by the number of student nurses who apply for their first post and sign a contract with their employer without ever having actually visited the area beforehand. Work is a big part of your life, and to work 8- to 12-hour shifts in an area that you have not visited is taking a risk. During your first year registered, you will need to consolidate everything that you have learnt during your degree, whilst also learning new extended skills. If you are happy because you find team members easy to work with, you have good role models and clear direction, then you will thrive during your first year. If the opposite is the case then you may struggle. My advice is to do your homework and not to take a risk in your first post.

Table 1.1: Handy tips to guide your decision when applying for your first nursing post

An informal visit usually consists of an initial one-to-one meeting with a senior nurse or practice educator from the area to discuss what the post will offer you, the potential applicant. A one-to-one in the office is usually followed by a walk around the area, or a home visit / patient consultation if it is a community setting. I would be very wary of applying for any job, even now, if during an informal visit they would not allow me to have a walk around the work environment to talk to current staff. During your informal visit make sure that you talk to the manager, current experienced staff and new starters, about the area and support they offer (see Table 1.2 for key questions to guide your informal visit). You can gain immense insight from current staff working in the role you are applying for during visits, which can inform your final choices later.

If you are applying for jobs that are miles away, it may not be feasible to conduct an informal visit. Alternatively, you can find out important information by having a telephone call or virtual meeting with the nurse manager, or by accessing resources from the clinical educators via email. Always check which specific area you will be working in and ask for information about the actual post and the support that will be offered to you before you arrive for interview. You should be offered an extensive orientation as a new starter nurse and you can request a virtual call and ask for copies of new starter orientation packs and study days to be sent to you via email. If they are not forthcoming following repeated requests, then consider applying elsewhere.

Table 1.2: Key questions to guide your informal visit

Most NHS employers have a 6-month probationary period for all levels of nursing staff to assess whether they are up to the job once appointed. Line managing a new starter out of a job is a worst case scenario and rarely happens, but it can occur. To prevent the risk of future disciplinary disputes, try to make sure that you are going to work in an area that is going to develop your confidence with structured support.

In summary, whether you attend an informal visit, or have contact via a telephone call or virtual meeting, I would always advise that you avoid any area that does not offer you a new starter orientation or structured plan of support when you commence your first nursing post, as they do not deserve to have you without this in place!

1.2 YOUR APPLICATION AND PERSONAL STATEMENT

Here are a few tips for writing your application and personal statement:

Ensure that you complete your application in time for the deadline as you will not be shortlisted after this date. Most applications are centralised through a Human Resources (HR) department, which makes it impossible to upload an application once the deadline has expired.

Make sure that your application is neat and concise, and does not contain spelling or grammatical errors. Ask friends, family, university academic advisors and peers to proofread your application prior to submission.

Do not falsify any data on your application as HR staff are trained to check the details and rigorous referencing checks will pick up inconsistencies.

Take time to write a personal statement that is personal to you and shows your strengths.

Your personal statement should make reference to the following three areas:

– the importance of compassionate patient care and how you strive to deliver individualised, holistic, patient-focused care that is evidence-based

– the importance of maintaining professional standards and how you aim to achieve this

– how well you work in a team and what you can offer your future employer.

Although managers will have individual areas they are interested in, these are the three key areas that most nurse managers will be looking for in a newly registered nurse application.

Always use language that you understand and are comfortable with, and do not just copy material that you read online or in books that you ‘think’ should be in a personal statement.

1.3 PREPARING FOR INTERVIEWS AS A NEWLY REGISTERED NURSE

There are some key areas that will be covered by interviewers during your interview; even if interviewers word their questions differently they will be probing for some key information from the candidates through their questioning. Table 1.3 provides details as to what interviewers are usually looking for, and some example questions are presented to help you prepare for interviews as a near to registering student or newly registered nurse.

You should also prepare for any potential spontaneous questions in your interview. Usually these are linked to current health care topics from media and nursing journals, so you should review current nursing journals and listen to the news channels for a period leading up to your interview for potential ‘hot’ topics. Current areas would include development of the new nursing associate role and changes to professional standards, e.g. 2018 NMC standards: Future Nurse: standards of proficiency for registered nurses (NMC, 2018a) and standards for education and training, presented in three parts (NMC, 2018b; NMC, 2018c; NMC, 2018d). Always review professional websites, such as the Nursing and Midwifery Council or Royal College of Nursing, for updates relating to standards of proficiency, education and training.

Often I interview newly registered nurses as the third interviewer, and when most key questions (Table 1.3) have been asked in some form by the first two interviewers, I will ask questions linked to something that the candidate mentioned earlier in the interview or wrote in their personal statement. If you say or write that you always provide ‘evidence-based practice’ or adhere to ‘clinical governance systems’, then you