Table of Contents
Meet Megan! She has written an absolutely amazing Guide To A Nursing Graduate Year. Use the contents page to sift through different sections. She covers everything from how to get a graduate job and interviews through to an in-depth exploration of her experiences and lessons learnt to help the next generation of graduate nurses succeed!
Introduction
Hello, My name is Megan and I am a registered nurse and midwife born and bred in Perth WA. I am currently completing a midwifery graduate program whilst also working 1 shift a fortnight in adult nursing.
Outside of nursing, I have a long list of half-finished arts and craft projects as I desperately seek a creative outlet, due to a deep-seated desire to be artistic despite having neither the talent nor the commitment to actually practice and grow in these skills. Instead, I default back to what I actually enjoy – which is baking, and my work colleagues also very much enjoy that this is my outlet for creativity and stress relief.
Why I got into Nursing & Midwifery
Ever since I was little I wanted to be a nurse, including when I was about 6 years old informing my parents that I wanted to be a nurse to actually help people, as opposed to a doctor who only pretended too (Don’t know what basis I had for forming this position). A lot of my childhood reading revolved around nursing books, such as Cherry Ames and Sue Barton – which didn’t really teach me anything about modern nursing.
However when it came to year 12 and deciding on university courses I decided, with all the decision making prowess of a 17-year-old that shift work sounded terrible and picked a different health sciences degree, which lasted all of half a semester before I decided to take a 5 year gap year, during which I worked and travelled and finally decided that I did want to study again, and what I wanted to study was nursing.
When it came to reapplying for university I knew which Uni I wanted to go to, it was close, it was familiar and most of my friends were studying there, but on an impulse, one day I decided to put in an application for another university as well, which was further away, wasn’t as “highly” regarded but did happen to offer a dual degree in nursing and midwifery.
This was the course which I ended up getting into. It was an interesting start to university studies as I found myself surrounded by women who were passionate about wanting to be midwives, and I didn’t even really know what a midwife was other than the vague idea that they were nurses who worked in maternity (they’re not), but I decided to give it a year to make up my mind whether to stay with the dual degree or to drop the midwifery and do nursing by itself.
It was hard work and it was challenging, we were course overloaded for the first 2 years, to be able to fit two 3 year Bachelor degrees into a 4-year time frame. In addition to the standard nursing and midwifery practicum hours, we also had to do continuity of care, which involved attending appointments and birth with women in our own time. I was also working at the same time, so it was a lot to manage, but in that year I fell in love with midwifery and stuck with the dual degree, graduating at the end of 2018.
Working as an AIN
I started my degree working as a casual for a government department, which worked well for me, as the pay was decent, but the casual nature meant that I could take time off that I needed for things like prac, whilst at the same time, I could have worked every weekday if I wanted to. However, I knew that I wanted to get a job in healthcare, to increase my exposure and skills. My university offered recognition of prior learning arrangement with a local university where after our first completed year of nursing studies we could apply for RPL and after a 1-day session, get our Certificate 3 in Acute Health Services Assistance. I was able to secure a job working for an agency which supplied AINs to local public hospitals.
Whilst (in my state anyway) working as an AIN does not directly impact on your chance of getting a public hospital graduate program, I found my experience and exposure invaluable in being able to use examples for answering questions in my graduate interview, and also for helping me to decide preference areas for my graduate program, as my nursing practicums had all been surgical speciality based.
The In’s and Out’s of Graduate Programs
From being in several nation-wide graduate nursing Facebook groups and from also looking into applying for graduate programs in other states I would say that the WA graduate process is the simplest, but it is also very much a putting all your eggs in one basket affair.
For those not familiar with how Gradconnect works, you put in an application which involves answering four selection criteria, filling out some resume details and providing two referees, and then you select 3 hospitals in order of preference. However, rarely will hospitals look at anything other than applicants who put them as first preference, due to the quantities of applicants that they receive.
My grad co-ordinator said that they get 3 applications for every 1 position they offer – and this is only applicants who put them as first preference. There are second and third-round interview and offers but it is very rare that hospitals have not filled all of their positions within the first round. Second and third round interviews will most often come from rural/regional areas who have not had sufficient applicants.
How to ace the Selection Criteria
The single most important thing for getting an interview with Gradconnect (applies to certain states only) is your selection criteria, this is the only thing that the hospitals can use to shape their decision about whom to interview, it does not matter which Uni you went to, what your scores were (as long as you passed) or what else you have done in terms of employment and extracurricular.
So my recommendation for graduates looking at applying is making sure that you know how to properly and succinctly address selection criteria, and get feedback on this, get it spell checked, hone it to perfection (seriously, there is a mark awarded for spelling and grammar). Since graduating I have helped a number of students to work on their selection criteria, and the most common error I see is people wasting a lot of word count, when they only have 250 words, on storytelling which does not address or answer the selection criteria.
I strongly recommend using the STAR model, especially for any selection criteria which ask you to demonstrate skills or knowledge, not only does it help keep you focused on the selection criteria, but it also makes it simpler for recruiters who are reading hundreds of applications to find the information that they need to grade your selection criteria.
The other thing I would recommend when answering selection criteria is talking to people to find out keywords and models used by the health department you are working for. For example, if you are writing about verbal communication and are using handover as an example, reference the ISOBAR model. If you are writing about conflict resolution with a patient, reference the LASSIE model. If you are writing about escalating concerns with patient safety or wellbeing, talk about graded assertiveness.
How to approach Nursing Job Interviews
When it comes to interviewing my tips would be, firstly – know your hospitals/interviewers values and ethics, and incorporate these into your answer as to why you want to work there. Secondly – have good questions prepared for the end of the interview (you also get marks for these).
In the words of my grad recruiter, a good question is one which isn’t something you should have asked before you applied, such as “what is the pay?” or “do you offer part-time graduate programs”, but instead things like “What do you enjoy most about working for this hospital?”, “What are you most proud of this hospital having achieved in the past 12 months?”, “what goals do you have for the hospital over the next 12 months?” etc.
Other than that, know that the questions you will be asked will be based on the selection criteria, so if selection criteria is asking about written and verbal communication in the multi-disciplinary team, expect to get an interview question which is based on written and verbal communication.
I was fortunate to be offered interviews in my first preference hospital for both nursing and midwifery, however, I was only offered a nursing graduate position. My key recommendation is if you apply or interview but don’t progress to the next stage, then ask for feedback. This was invaluable for me because even though I took my nursing offer (and I do love nursing) I still wanted to pursue a midwifery graduate program to consolidate my skills and knowledge.
So when I interviewed and didn’t get an offer, I asked for and got valuable feedback, then I applied again the next year. I, unfortunately, didn’t even get an interview, but again asked for feedback and got some great information on how to improve my selection criteria. Not all feedback will be the same, unfortunately, some peoples experience has simply been being told “you did well but someone else did better” however for me in both situations the person providing feedback went through what they were looking for which I had not addressed.
In my last opportunity to apply for graduate programs (WA allows 2 years from graduating) I was able to secure a midwifery graduate program, and I am currently halfway through this program.
Do you have to do a graduate program and what is the point of doing a graduate program?
No! you do not have to do a graduate program, however, what I say is that securing a graduate program is the “easiest” way to secure hospital-based experience because even though the application and hiring process is competitive, you are only competing with other nurses who are inexperienced/graduates.
Once you have your registration you can apply for any level one/entry nursing position, however, you may be competing against nurses with 2+ years of experience. Also, graduate programs are great if you want to be a hospital-based nurse, but not everyone does, and the beauty of nursing is that there are lots of opportunities to work in a large variety of different areas.
The point of a graduate program is to help support you to transition from a student to an RN, however not all graduate programs are equal. For example, my nursing graduate program involved, 3 additional study days and I had to write a reflection on quality improvement, as well as getting signed off on reading the policy & performing 12 key skills (which all new starters at the hospital have to do).
My midwifery graduate program involves 8+ study days, skills to be signed off in all areas of midwifery practice, monthly reflections and preparing and presenting a case study. However, my nursing graduate program had grad coaches for the first 6 weeks, who were nurses who were on temporary secondment and were there to give you support and help you with time management, patient care etc (I believe they had about 12 grads that they had oversight of)
Where did you do your graduate year?
I completed my nursing graduate year in an acute medical ward at a major tertiary hospital in Perth. It is a 50-bed ward, including 8 high acuity beds, as well as having an ambulatory clinic, where we see a mix of patients returning to get results and for follow up, as well as short-stay cases referred from either GP’s or ED.
Being acute medical we take almost all medical specialities, with some exemptions – basically when: they are only predicted to need a short length of stay <48hrs, OR we haven’t figured out what speciality they should go to yet OR we know where they should go but that speciality doesn’t have a bed for them – but they need to go somewhere other than being bed blocked in ED.
The kinds of the patient’s that we see include geriatrics, falls and functional decline, TIA’s, Syncope (as we can cardiac monitor), palliative, eating disorders, infections & sepsis, upper GI bleeds as just a snapshot of some of our patient types.
Because of the diversity of patients that my ward receives I can’t even begin to describe what a typical day is like or a typical patient, other than it involves a lot of Obs and meds. My patient demographics rang from 16 through to 102 (a very spritely old lady who was exceedingly proud of how good she looked for her age), from a diverse range of cultural and ethnic backgrounds. However, the majority of our patients are over 65, as reflects the majority of hospital patients.
What are your ratio’s like and how did you seek assistance when you were busy?
My particular stream of the graduate program didn’t rotate, so I did 12 months in the one area. I found that I did enjoy this as I got to build good relationships with the staff, and also because of the diversity of the patients I found that I learnt, and am still learning so much. In WA we don’t have legally mandated ratios, however, my ward operates on average on a 1:4 nurse to patient, except for the high acuity area. In a perfect world that is 1:3, however, if we are having to absorb specials, or are over census we can go up to 1:5, and certain patient types in the high acuity area require 1:1 nursing.
We are frequently either over the census or absorbing specials, so 1:5 is quite common. I work a mixture of AM & PM shifts across all days of the week, graduates don’t do nights for approximately the first 4 months, but once we are doing nights the standard rostering is 6 weeks of days, 2 weeks of nights.
Because of the nature of the area that I work in and high patient turn over, we also have a Flow nurse, who helps with working out discharges and admissions. As well as having a Float nurse on PM shifts. We team nurse in Pods of 3 nurses, to 12-15 patients, I definitely found that I preferred this, especially as a graduate because even though we still allocate patients to specific nurses within that Pod, it meant that someone else had your back, and was familiar with your patients. Whereas in midwifery on the post-natal ward it was just individual allocation, which I found more challenging to begin with.
In my nursing graduate program my first port of call for assistance was my pod leader, but If I needed help with a specific clinical skill and my pod members were busy I could go to the educators on weekdays and seek assistance from them. I also had graduate coaches available to me for the first 6 weeks. My strongest recommendations for graduate nurses is don’t be scared of asking for help and don’t think that you are failing/a bad nurse because you need help. I remember it bothering me my first couple of months that no matter how hard I worked, I could only just barely get my work done and I never had time to help out my other team members.
But over time things will start to fall into place, and your time management and clinical skills will improve, and suddenly you’ll be the one who is helping your colleague who is snowed under. Remember that you are not a nurse with years of experience under your belt – you are a beginner, so you will perform as a beginner and that is OK. The most important thing is that you are safe, and that means knowing your policy & procedure, knowing your capabilities and knowing when to ask for help. You will also learn which nurses to go to for help.
Did you do any upskilling in your graduate year?
I didn’t do any specific upskilling in my grad year, as skills such as IV cannulation were not supported in my ward area, however, I had two elective study days and I chose to use those to pursue an area where I felt I was lacking and an area that I was interested in. I did a study day on precepting, as I enjoyed working with students, and often ended up inheriting students if the nurse I was working with didn’t like working with students.
I also did a study day in wound care, because it was an area that came up frequently on my ward, as many patients presented with complex co-morbidities including wounds, and I didn’t feel like I had much experience or knowledge surrounding wound care. Ironically the week after my wound study day we had a patient present to the ward who had a pressure dressing on in the community, and I was the only one on the shift who was familiar with the pressure units and the importance of switching from a rental pressure unit to a hospital-owned pressure unit.
Whilst technically I was a mature age student, I didn’t feel like a “mature” student, as I was still in my early/mid 20’s and living with my parents. What I would say is that it is hard going from having a full-time income to living on a student income, and if I was to do anything again it would be to have more savings under my belt before I started.
What are some patients you have learnt important lessons from?
Eating Disorders…
Eating disorder patients, these patients can be very emotionally complex to look after, and my understanding is that my state is the only one in Australia which does not have an inpatient adult eating disorder unit, so the typical journey for these patients is that they would come to our ward to be medically stabilised, which can take days to weeks, so they may either go to a general medical ward or if stable be transferred to either inpatient or community mental health services.
For me, these patients highlight the problems with a fragmented health care system where patients are often streamed and treated based on a specific problem, rather than holistically. Eating disorders aren’t just silly girls who don’t want to eat, these are adults who have a serious mental health issue, which physically manifests as their eating disorder, and is often co-existing with trauma and/or abuse. However unfortunately they often didn’t receive comprehensive mental health support until they were at a certain level of physical wellness.
Building rapport can make such a big difference when working with these patients, and providing choices where choices are available. For example, the patient may not have a choice about whether or not they have a NGT tube, but talking about it and offering them the option of self-insertion can improve compliance and reduce the risk of needing security involvement.
Advocate for yourself
Early in the graduate program, I had a patient who had presented due to infected diabetic leg ulcers but also had multiple co-morbidities. I remember this shift because it was the first time I had to give an Iron infusion – I asked for help as I hadn’t done given iron previously, but the nurse I was with just told me to read the policy, which I did.
However, in the rush, I missed the information about the frequency of observations. Also within 30 minutes of the infusion beginning the patient had to go for an Abdo X-Ray, but needed escort because of the infusion, and no sooner had we returned to the ward but the patient had to go for a chest X-ray which had been ordered on a separate form!
The patient had to be escorted again, and by the time I was back on the ward it was handover time, and the oncoming nursing team pointed out that I had both missed the observations required for an iron infusion, but I had also in all the to-ing and fro-ing missed the lunchtime insulin for this patient.
Not going to lie, I cried about that (at the nurse’s station as I desperately tried to get my notes written), but what I learnt from this was advocate for yourself, if you aren’t comfortable doing something by yourself find someone to help, even if it isn’t the first person you ask.
Advocate for your patient
Patient advocacy is also a skill that you will need to learn and develop as a nurse, but learn who your allies are in that as well. A couple of examples of this are: I had a patient who had presented with lithium toxicity, the primary treatment for which (in mild cases) is adequate hydration. The first day I looked after her she had been on IV hydration running and was taking her oral tablets & food with assistance.
The medical team reviewed her the next morning and stated that she was cleared for discharge as she was tolerating oral intake and had down-trending lithium levels, and instructed that her IV cannula be removed, despite the patient having refused all medication that morning. I wasn’t happy with this decision as the patient had deteriorated since I had cared for her the previous day, and I discussed this with the coordinator who supported me to leave the cannula in place until the patient had been reviewed by the psychiatric team, who refused discharge. As the patient’s lithium levels were still toxic, she had declined from the previous day and she needed ongoing IV therapy.
When did you wish you advocated more than you did?
This doesn’t mean I was always a fabulous patient advocate, I had another patient who was a GI bleeder, with ongoing haematemesis, who was waiting for a non-urgent scope as his vital signs were stable, but I could see that he was not as well as he was the previous day and that he was deteriorating. In retrospect I wished that I had vocalised this to the medical team earlier, because the patient (who was otherwise relatively young and healthy) ended up massively dropping his blood pressure, being a MET call and going for an emergency scope, because he couldn’t compensate for the blood loss any longer. Whilst this patient made a full recovery, there is a reason that MET call criteria includes, “other concerns” even if the vitals are stable.
Always check the bladder if a palliative patient is in pain…
Palliative patients – make sure that their family knows that you will still be caring for their loved one. No observations doesn’t mean no care. And if you’re doing everything and that person isn’t comfortable, think about what hasn’t been done, or who that needs to be escalated to. Because comfort is your goal with palliative patients.
An example of this is receiving handover that a daughter was being pushy, and insisting that her mother have the maximum doses of palliative medications as frequently as she could. My first course of action was introducing myself and letting the daughter know that I was going to get her mother more medication, as it was due, and that after that I was going to scan her bladder.
The Daughter expressed her relief, as she had felt that she had had to keep asking and that her mother wouldn’t have been cared for if she hadn’t advocated for her. After giving medication I bladder scanned and the woman had over a litre of urine in her bladder, as soon as we put an IDC in the woman settled, and she only required one further dose of pain relief during my shift. So always check the bladder if a palliative patient is in pain, even if you have wet pads because it can be overflow from a distended bladder.
Tell us about your first emergency
My first emergency as a graduate was in my first week, and I was completely unaware of what to do, other than press the emergency bell. One reason is that I found at university and in induction, we were drilled in management of cardiac arrest … but my patient hadn’t arrested, they had significantly dropped their GCS, and I didn’t know what to do.
Despite all the training I’ve had, in almost 2 years of practice, I have never yet had to perform CPR, and I’ve only ever seen it performed once. But even though I didn’t know what to do in this example, everyone else who came did know what to do.
My fabulous clinical educator, who was one of the first to attended saw my panic and gave me this advice, which I think is highly valuable “When you’re a grad you don’t need to know all the ins and outs of what needs to be done in an emergency call because you are surrounded by experienced people who do know, your job is to give a brief handover to people attending and let them know why they’ve been called”. This particular patient ended up being stroke called, and again my educator came with me to radiology for the CT, and stayed with me to help care for the patient when the decision was made to palliate them. Ironically I haven’t had a single stroke call since!
Another memorable emergency call was during my first night shifts, where my patient had been snoring all night, but at about 1 am the coordinator went “their snoring has changed, let’s go check on them” and the patient was unrousable with a blood sugar too low for the monitor to read. As soon as we gave him an IV glucose treatment he came around and was quite cranky with us all for being in his room with all the lights on, asking him questions in the middle of the night. So listen to your nursing gut, and listen to your colleagues as well.
What were some of the positives and challenges of your grad year?
The speed of turnover and diversity of the patient cohort. Our rate of patient turnover can be very challenging, some days you are filling your beds as quickly as you empty them, sometimes your next patient is in the corridor before your previous one has even left yet. I have had shifts where I have ended up having to write notes for 10 patients, and do 5 admissions because I’ve discharged all my bed spaces. I’ve had shifts where I have discharged, admitted, discharged again and admitted again the same bedspace.
The diversity of the patient load also means that there is so much to learn. However, I also found this a positive, as I felt I got a really diverse graduate year and didn’t feel like I was pigeonholed into a speciality area. A great positive about where I worked is that I feel the challenges and stresses helped to forge a great nursing team who all pitched in and were very supportive
What surprised you the most about your graduate year?
What surprised me the most throughout my graduate year, was how much I actually did know. Going into it I felt like my mind was a blank slate that had retained nothing that it had ever learnt, and yet I would surprise myself by what I did remember and the clinical knowledge that I did have. The other thing that surprises you is how much you do learn, how one day you discover you’re doing something as second nature which used to throw you into a tailspin.
The biggest learning curve?
I mean the whole year was an ongoing learning curve – but I think one of the things I really had to learn was communicating with the medical team, such as, whom to communicate to and how to communicate a concern.
Key tips were – have all your obs up to date and take the file with you when you go to speak to the doctor. Know exactly what your concern is and communicate it clearly, and If you’re not sure, then clarify the plan. I was fortunate in my ward because we had 24/7 registrar & RMO cover on the ward, but especially If you are communicating to an after-hours doctor who may be covering multiple wards, make sure you offer a quick clear handover of which patient you are talking about.
What do you wish you had known earlier?
I felt like I would have liked to have had an “education” week to start my grad, where we covered all the things that I found out at study days months later, things like; any patient on oxygen for more than 2hrs requires a prescription (a fact which still appears to surprise the medical team).
What mistakes did you make that you’d like others to learn from?
The mistakes that I made that I would like others to learn from – Check the time on medications! I only made a couple of medication errors, fortunately, none of them significantly impacted the patient, but all of them revolved around giving medication at the wrong time (for example giving an evening medication in the morning)
The advice I would give a brand new grad
- Ask questions!
- Ask for help when you need, and accept any help offered even if you feel it isn’t needed
- Be kind to yourself and DO NOT compare yourself to more experienced nurses
- Sometimes you just need space and if that means taking your personal leave as a “mental health day” do it! Nursing will always be there, don’t burn yourself out your first year
- You aren’t going to get a lot of feedback, at least not the positive kind, it’s not like being a student. Depending on your personality type this might be a challenge for you. I know that I really struggled with irrationally feeling like everyone hated me and that they all thought I was the worse, most incompetent grad that they had ever worked with.
- 1 – If there are concerns about you being an unsafe practitioner or that you are doing things wrong, these will be brought up with you.
- 2 – People won’t necessarily give feedback, but there is nothing wrong with asking senior nurses for feedback, I did this a couple of times throughout my graduate year
The advice I would have given myself as a new graduate – be kind to yourself, you don’t need to be perfect, you are learning and you are growing.
What’s next for your career?
I don’t know! I am currently working in my midwifery grad program, plus still working in adult nursing and I’ve just started a graduate certificate for midwifery which is part of the pathway to becoming an endorsed midwife, but I also do love my nursing home and the team I work with there, as well as still wanting to develop my skills in nursing. Part of my soul still niggles that I would like to experience working in ED. In addition to this, I love working with students and part of me wants to do further studies in this – I have a growing list of postgraduate studies that I want to do!
The beauty of nursing and midwifery is that it offers so many opportunities, but the challenge also is that it offers so many opportunities!
We hope you thoroughly enjoyed and learnt something from Megans article.
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