things they don't teach you in nursing school...

Going against the pack mentality of some of the more experienced nurses. Sure, in school, we are taught to embrace change and learn all kinds of new things that may or may not be beneficial to the area in which you finally work. Just good luck in getting some of the more experienced nurses to care. Many times, it is very hard to get them to see beyond the way things are always done. It is a slippery slope to fall into; sometimes you are even pushed in order to conform and not upset the balance that is established.

How to deal with difficult families. Only experience gives you this inside trick. Sure could have used it lately too. It is difficult to get frustrated at your new job and then have that compounded by families who are now empowered with a plethora of information from the internet or keen eavesdropping skills. It is also as if the families can smell new meat and feast accordingly.

Ways to incorporate your newly learned skills and knowledge into your job. You are new and so people tend to not take you seriously. Often times, things you say or do will be discounted because, well, you are new. You have no experience. You need to learn the “real world” of nursing, or so they say. Also, this is frustrating because you need to develop your own skills along the way… and it is also used to get you to conform to the “old, better way” of doing things. May as well hang the sign that says “Change not welcome here” above the entrance on some days. If you are lucky, you can work in a progressive environment that is willing to accept that a new grad may actually know something :) In some ways, I am lucky to have a portion of that environment. I know that administration (believe it or not) is working to make our lives as nurses better, it will just take awhile to for it to be accepted.

Dealing with the stress of the job. Sure, you learn to cope and manage in school and how to deal with that stress. Often times, those same coping skills do not assimilate well into the job. When working with no new people, it is difficult to get them to remember what it actually feels like to be a new graduate. Things were done much differently back then, weren’t they? But they forget what it is like to be unsure of yourself, and building your confidence in your new job can take a good amount of time. Are your co-workers enablers or disablers? Will they give you a good environment to encourage your skills and build that confidence or will they disable you completely, make you feel burned out within 6 months because you are never able to make that step forward? Will you go home and cry because you feel that it is just too difficult to manage some days? Maybe you might even cry on the job. Is that a sign of weakness or just simply poor coping skills. Maybe it is just learning when to take a step back for a moment to gather composure without interfering eyes that refuse to encourage you or give you advice on what to do. You may need to figure it out on your own, and it shouldn’t be that way.

No situation is perfect. In school, you deal with textbook situations. More times than not, you will be confronted with cases [patients] who are not textbook. You have to rely on the experience of others to guide you through, and this can be difficult in so many ways. Not only for you as the new nurse, but also as you the former student not long out of school. You want to rely on the textbook, but it can fail you. It gives you the guidelines and the basics in which to follow, and then you need to adapt those guidelines to each patient. Much like how you adapt your care plans, but in the real hands on setting. If you aren’t able to rely on your co-workers to assist you through these situations, you can remain completely lost. Someone you work with is a good mentor. Seeking that person out can be a long process, and I hope that you find that one person.

Utilizing resources. As a new grad, you are a blank slate. Of course you learned a lot in school. You learned exactly what you need to learn in order to pass boards. You learned a lot in clinical that gives you some hands on experience. But what they don’t teach you, or really can’t teach you, is how to use the resources at your new job. The instructors don’t know where you will go once you leave their nest. You have to actually sit back and watch others, see where they go to find answers. And if in doubt, you can always pull out the policy and procedure manual. It is full of answers specific to your facility.

I am sure there are more…