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This page intentionally left blank
The Newly Qualified
Nurse’s Survival Guide

SECOND EDITION

JACKIE HOLE
RGN, BSc (Hons), PG Dip Practice Educator
Productive Ward Facilitator
St Richard’s Hospital, Chichester
Royal West Sussex NHS Trust

Foreword by
MOIRA DAVIES
Chair
RCN Practice Education Forum
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2009 by Jackie Hole
CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Version Date: 20160525

International Standard Book Number-13: 978-1-138-03094-7 (eBook - PDF)

This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts
have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any
legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that
any views or opinions expressed in this book by individual editors, authors or contributors are personal to them
and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this
book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement
to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant
manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical
science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader
is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material
manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or
materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suit-
able for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her
own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also
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 Contents

Foreword to second edition ix

Foreword to first edition xi
Preface to second edition xiii
Preface to first edition xv
About the author xvii
Introduction xx

1
Pre-qualification 1
Management/supervised practice placement objectives 2
− Allocation and delegating skills 2
− ‘It’s not what you say, it’s the way that you say it’ 3
− Management of a group of patients 4
− Doctors’ rounds and case conferences 6
− Drug rounds 6
− Off-duty planning and staffing issues 7
− Ordering of supplies 9
− Use of the computer 9
− Sister’s meetings 9
− Knowledge of policies and procedures 10
Important points to remember when looking for a job 10
Interview skills 11
− What will happen at the interview? 12
− Handy hints 12
− What will they ask? 13
− What shouldn’t I do? 14
 CV writing and application forms 14
Portfolio building 15

2
Post-qualification: the first few weeks 19
Your first day 20
− Cardiac arrest procedures 21
− Fire evacuation and procedures 23
Over the next few weeks find out about . . . 24
− Case conferences 24
− Taking charge of your group of patients 24
− Fundamental nursing care 24
− Undertaking a ward round 27
− Patient admission 28
− What to do in the event of a death 29
− Ward philosophy of care 30
− Doctors’ rota 31
− Nursing rota 31
− Senior nurse support 32
− Working on the nurse ‘bank’ or doing extra shifts 33
− Electronic equipment 33
− Important policies 34
What are your personal objectives? 34

3
Drug safety 37
Your objectives 38
Intravenous infusions 42
− Cannula care 43
− Infusion safety 43

4
Infection control 45
Clostridium difficile 47
MRSA bacteraemias 48
Targets 49
5
The next two to six weeks 51
When to contact doctors 51
Preparation for theatre/investigations 52
Post-operative care 54
Nasogastric (NG) tubes 56
Percutaneous endoscopically guided
gastrostomy (PEG) tubes 59
Enteral feeding 60
Urinary catheterisation 61
Blood transfusion 64
Referrals 66
Clinical supervision and reflection 67
What should I do if I make a mistake? 68
Professionalism 70

6
‘The six-month tears’ 73
Attending study days and courses 74
Important NMC publications 75
Accountability 76

7
Your first year 77
Prioritising acute care 77
Appropriate delegation 80
Time management 81
Flexibility in emergencies 82
Budgeting 84
General finance 84
Lost bed days 85
Staff management 86
Off-duty planning 86
Clinical supervision 87
Consultants and their specialities 88
Clinical nurse specialists/lead nurses 88
Consultant nurses 89
 Hospital bed management 89
Mentoring students 90

8
The future 95
Keeping yourself up to date 95
Extended roles 96
Individual performance reviews (IPR)/appraisals 98
Sharing your knowledge 98
− One-to-one teaching 99
− Group teaching 100
− Golden rules! 101
The productive ward 102

9
Common clinical problems 105
Assessing an acutely unwell patient
(adapted from Smith 2003) 105
Breathlessness 107
Chest pain 108
Abdominal pain 109
Oliguria 110
Neurological deterioration 111
Confusion 112
Seizures 113
Haematemesis/per rectum (PR) bleeding 114

Checklist 117
References 121
Index 123
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 Foreword to
second edition

It does not seem like four years since the publication of this very useful
survival guide, and I am sure that many newly qualified and experienced
nurses have found this book an invaluable tool during this time.
As acknowledged by the author, much has changed within nursing
during the past four years, and more challenges and changes within
the profession are likely over the next four years, not least the move to
degree level study for pre-registration student nurses.
However, it is also acknowledged that the delivery of high standard
essential or fundamental care by registered nurses has in essence not
changed and this edition continues to guide and support you in this.
The excitement and trepidation that affects all final year nursing
students during the last placement, transition to Registered Nurse and
commencing the first staff nurse post cannot be underestimated. The
advice given in this guide can act as a framework to this journey and
support and work with the preceptorship received during this key time
in the professional life of a Registered Nurse.
 x FOREWORD TO SECOND EDITION

Over recent years it has been recognised that newly qualified nurses
do require support during the first year and preceptorship is one of the
keys to this. This edition is again recommended to experienced nurses
who act as preceptors, from the perspective of their own practice and
to support them in their role as a preceptor. The range of information
and examples given can help support both the newly qualified nurse
and the preceptor – the checklist continues to be a really useful tool.
Good luck in your transition from student to Registered Nurse, and
the first stage of your career as a part of a caring profession. I hope
you will find this book a useful resource in this journey and it will
become a well-used text during your first year after registering and
well beyond.

Moira Davies
Chair, RCN Practice Education Forum
November 2008
 Foreword to first
edition

This is truly a comprehensive, user-friendly survival guide for the

newly qualified staff nurse, equating to a ‘being a registered nurse for
the terrified’ handbook. This feels like someone is holding your hand
throughout those first days of the responsibility of being a Registered
Nurse at last.
Your role and responsibilities are made clear, and there is excellent
guidance to help you to find out where you fit within your organisation,
giving you a wider view of the targets underpinning healthcare.
In addition, there are management aspects, including delegation,
objective setting, budgeting, and the book also addresses those difficult
concepts like prioritisation of care and time management. There is
much sensible advice about looking after yourself, making sure that
you are fed and watered as well as everyone else.
The book sets you off on your journey from getting the most out of
your final placement, preparing the application for a post, easing you
into dealing with common clinical problems, using experts to help you,
then towards becoming a mentor and gate-keeping the profession.
 xii FOREWORD TO FIRST EDITION

It is also highly recommended for more experienced nurses as a

refresher to their knowledge, as it contains a wealth of fundamental
practical advice about good nursing care, all in one book. One vital
phrase that jumped out at me was to ‘look at your patient’, one of many
truly practical yet essential pointers towards becoming an effective and
caring professional nurse.
The examples given bring the advice to life, and the wise words are
completed by a checklist so that you can see your achievements.
Good luck to you as you embark upon your career in nursing, and I
hope that this becomes a well-worn text used for reference and advice
for at least the first year!

Sue Hopkins
Chair
RCN Practice Education Forum
October 2004
 Preface to second
edition

Four years on from the first edition of this book so much has changed
within nursing and the NHS. However, the essentials of nursing care
have not changed at all. I can’t believe that it was four years ago that
I was writing the original preface and so excited about publishing my
first book.
I have had many newly qualified nurses within my Trust and also
from other Trusts contact me to say how much they have enjoyed
reading the book and how it has helped them. This is really great
to hear as this is exactly why I wrote the book in the first place – it
certainly wasn’t to get rich!
I am now a Modern Matron within the Emergency Division of my
Trust and still have lots of contact with newly qualified nurses. They
still have the same worries and struggle with the same issues. This post
has enabled me to heavily influence the standards of care experienced
by patients and I take great satisfaction from this.
I still believe that good nursing comes from within and that it
 xiv PREFACE TO SECOND EDITION

is definitely influenced by positivity of mind and from well-taught

standards. High standards are increasingly important in an NHS where
the patient dependency and acuity is increasing and where efficiency
and costs are influencing resources.
The induction and support of newly qualified nurses has improved
over the past few years and standards such as supernumerary status
during induction have helped new nurses to settle into the ward teams
more effectively.
I hope you enjoy this book and are heartened by the fact that
all newly qualified nurses feel and experience the same worries and
problems (and joys!). Be proud of the fact that you are now qualified
and that all the hard work has paid off. After 18 years of nursing I still
love being a nurse and feel very privileged to work with some of the
best staff and be able to make a real difference to patients.

Jackie Hole
November 2008
 Preface to first
edition

I have been qualified as a staff nurse for 11 years. During those years
I have had many experiences of good and bad nursing. It is my belief
that good nursing comes from within and is not an attitude that can
be learned. I feel that if you start off well in your career and learn
how to nurse in a thinking and empathetic way, your patients will
reap the rewards and you will never lose those qualities. Throughout
your nursing course you will have had structure and processes to
follow (sometimes too much!) which have guided you to learn the
appropriate skills and gain the knowledge required to become a staff
nurse. However, once qualified this structure all but disappears and
you can feel ‘abandoned’.
My background is mainly within medical nursing, where I managed
to reach the dizzy heights of ward manager. Following this and having
always wanted to be involved in clinical education, I obtained the post
of clinical placement facilitator. My remit was to ensure an excellent
learning environment within my NHS Trust – the Royal West Sussex
 xvi PREFACE TO FIRST EDITION

NHS Trust in Chichester. This role meant that I was often in close
contact with newly qualified nurses. I felt that they lacked direction
and needed to know that they were not alone. It was for these reasons
I decided to write this book. I hope that you find it useful and enjoy
reading it.

Jackie Hole
October 2004
 About the author

WHEN DO YOU KNOW THAT YOU WANT TO BE A NURSE?

For me, it was when I was still at school. I can’t actually remember
thinking, yes, I want to go into nursing, but I knew I wanted to look
after people. Originally I thought I wanted to be a children’s Nanny.
I went to College to train, but soon realised that I wanted more than
that. The course that I did enabled me to experience all sorts of caring
skills and I was then able to identify that nursing was what suited
me best.
I worked in a Nursing Home at weekends and learnt how to give
good fundamental care. I applied to do a Pre-Registration Nursing
course at three schools of nursing.
My first interview was unsuccessful and I thought it was the end of
the world – it was all I wanted to do. I knew that I couldn’t give up and
that I would make a good nurse. I went to my second interview and
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