Graduate Nurse survival guide - Confidence, wellbeing and success in your first year

Nick Bridge: Welcome to the Nursing and Midwifery Health Program Victoria podcast series, where we'll be diving into issues that impact the way nurses and midwives navigate today's ever-changing world. I'm Nick Bridge, a registered nurse and senior clinician at the Nursing and Midwifery Health Program Victoria, and host of this podcast. The Nursing and Midwifery Health Programme is a support service which provides care and assistance to nurses, midwives, and students by experienced nurses and midwives. We provide a space where our colleagues can bring with them any sensitive health issues impacting their wellbeing. It's free to access, confidential, and independent. Joining me today on the podcast is Michelle Rutherford. Michelle is a registered nurse, Adjunct Associate Professor at Monash University, Deakin University, and LaTrobe University, and the Director of Nursing Education at the Royal Children's Hospital in Melbourne. Michelle has very kindly agreed to join us today to discuss and share her knowledge, experience, and insights into navigating nursing in the first year of practice. Welcome, Michelle. Thanks so much for joining us today.

Michelle Rutherford: Thank you. Thank you. I'm really pleased to be here.

Nick Bridge: So, Michelle, tell us a little bit about, I guess, your journey to where you are now.

Michelle Rutherford: Yeah. As you said, you've talked about my current role, and I've been in educational leadership for 15 years. But prior to that, my clinical background was in neuroscience nursing and I realised really early on in my clinical career that making a difference was where I really had a strong passion in making a difference in clinical care, but also in making a difference to the experience of nurses. So that early career, and through that pipeline from early career graduate to postgraduate, those were the opportunities to really support people to then support great patient care. So, it felt quite intentional for me to really pursue education. So, I did the clinical work in terms of that neuroscience and as a clinical nurse consultant, and then moved more into education. So ,I had worked as an educator as well, but certainly moved into that educational leadership role due to that real passion to make a difference, and it really is a privilege to work in an education role because you do have the opportunity to really help set people on a really positive pathway for their career. Most people will tell you a story about their early days as a nurse and the person who made a difference and helped them and I think that to be able to really build a cultural learning within an environment and have teams and individuals that really support people on their career path, it just makes all the difference and nursing is a tough career at times. If we set people up right from the outset to have really, really great support and strong careers, it makes all the difference. And that, for me, just was so rewarding. I experienced that. I really had great support in the early years to help me with, from a clinical safety perspective, but also from a wellbeing perspective. So, it's about giving back and looking at how can we do our best to support great patient care, but also support nurses as career, to consider it as a lifetime career, really.

Nick Bridge: Yeah. Fantastic, Michelle. But I would imagine that over your career, and especially working in very large organisations at the levels that you've been, you would have met hundreds of nurses graduating from university and entering into their first and second years of their career. Some really thrive, others struggle a little bit. What are the sort of things you've seen in early career nurses and graduates in particular that are qualities that help them to thrive during that first year?

Michelle Rutherford: Yeah. It can be quite difficult. It can be quite tough for them. I think being curious and being really open to feedback in those early days is really important. I think always being open to feedback, to be honest. There is a bit of a misconception at times that coming in as a registered nurse, you're ready to hit the ground running, you're ready to go, and you should be able to manage everything. But in actual fact, it's just the starting point and I think that a new registered nurse, a new graduate, if they're willing to learn and really kind to themselves and remain curious and open, then that will really set them up to succeed. It's a long game, I guess and they really need to be kind on that journey and just be open to listen and learn and take the feedback that they're receiving from different areas and look at what they can do to improve themselves.

Nick Bridge: You mentioned that there were misconceptions to respect to how graduates sort of integrate, I guess, in their first year. What are the sort of biggest misconceptions they have before they start, or some have before they start? … and you mentioned the word feedback as well, which I'll come back to. But what are some of the things that you think that graduates need to sort of be clear about when they start in their careers?

Michelle Rutherford: Yeah. Yeah. I think there's misconceptions for the learner and for the graduate, but there's also misconceptions for nursing teams or clinical teams as well. If I look firstly at the misconceptions for the graduates, I think often they expect to be feeling more confident or feeling confident really early and they may see their peers looking really confident. So, I think the misconception is that the first, within six weeks, you'll be able to do this. I think we really need to be kind to ourselves as new graduates and understand that our learning journey is completely different to the next person and that building of confidence, there's a lot of different factors that come with that and lots of human factors. So, we need to be kind to ourselves as learners, both as graduates and as nurses overall, and really learn at our own pace, but learn in a way that maintains safety and maintains our wellbeing as well. 

The other misconception, I think, as I mentioned, was really around that the expectation is they're a registered nurse now. They're registered without Ahpra, the same as other registered nurses, that they should have a level of immediate capability and I think that whilst they have the theoretical preparation and the placement preparation in clinical practice, the level of responsibility and accountability that comes when you're new into a role and that transition, that can be a lot. And I think it's really important that clinical teams also remember that we've all been there once and that they need support and need varying support as they develop and that they're not ready to hit the ground running and they may feel lots of different things in their first 12 months or two years, but that we need to customise the support and really ensure that they understand that it's okay. It's okay to ask questions. It's okay to provide feedback. It's okay to do all of these things to really help them on their journey into practice.

Nick Bridge: Yeah. Yeah and that kind of word, feedback, they have a perception that some of the feedback, or the feedback they receive, is a personal criticism. But in reality, sometimes it can feel like that. But in reality, unless there's feedback, there's no way to really grow and reflect on your practice. So, it's so important, as you've said, to be open and curious. That's great advice for graduates starting out in their career. And the way that impacts confidence, and that's just a huge thing that I think people struggle with when we have graduate nurses coming to us and midwives coming to us in the doldrums and really anxious or worried about their career progression or feeling like they are not coping. And the issue they have is an issue of self-confidence. What would you say to registered nurses and newly registered nurses who feel like they're not ready?

Michelle Rutherford: Yeah. Yeah. It's a good question. We can all have times in our career or in our personal lives where we don't feel ready for a change. And I think it's important that they sit with the discomfort, firstly, that it's okay to feel those feelings, to seek a network, that it's really important that we find our people, which might be other nurses in the clinical area, or it might be their previous students that they've been with as well. But really, to talk through some of those feelings, to identify with what other people are feeling as well, because that shared experience can be very helpful. Obviously, using the services available. But if it's the initial, "Oh, I just don't know," I think it's really just having the confidence to take the first step and just focusing on the immediate and not looking 12 months down the track, just looking at the immediate. What do I need to do now to get through today? And how can I see today as a really positive and valuable day for my learning?

Nick Bridge: I love that. That's a bit like saying be present.

Michelle Rutherford: Yeah, it is. Yeah.

Nick Bridge: Yeah. Take each day at a time and be present in what you can experience and learn at the time. I think that's really great advice. Yeah. Thanks for that.

Michelle Rutherford: Because it can become overwhelming. There is a lot. There's a lot for them to think about and a lot to take on, but it's just sort of bringing it, as you say, down to the present so that it can help them focus on that day. And often, we get through that day, and it's much better than we thought it would be.

Nick Bridge: Yeah totally agree. I mean, of recent times, there's been some difficulties in positions being available for new graduates. It's not that we don't need the nurses. It's that there aren't that many graduate positions available. Hopefully, that will change in the near future. Certainly, I know there are discussions around that at levels well beyond my pay grade. But what would you say to graduates who are looking for opportunities in graduate programs? How would you suggest they best prepare themselves? And what really stands out in their application and interview processes?

Michelle Rutherford: Yeah, and every health service has obviously different detailed processes. But certainly, when looking for positions, I always like to focus firstly on the values of an organisation and really look at what values would align with my values as a person because I think we take our values into work, but we also live those values as well. They're not things that we can switch on and off. And so looking for alignment in those is really important. And also, in terms of preparation, they've got 12 months before they're looking to apply for a position. Trying to align some of the work outside of their studies to their future career pathway. So for example, there are opportunities in different health services for RUSON positions or assistants in nursing-type positions, which is really beneficial. 

If they can obtain one of those positions, that's always great to help with getting some experience. If they don't have opportunities for that or they need more consistent work, for example, customer service in any area is something that really your communication skills, flexing and practicing your communication skills is really, really valuable and that can be seen really positively, as well as volunteer work that might align with the organisations you're interested in as well. So looking outside some of the things. So when health services are reviewing applications, they're sort of looking holistically at the applicant and what they've done and what their commitment is for the future. That can really help. 

And then in terms of the application, being your authentic self in the application as much as possible. There's obviously lots of use of artificial intelligence and different things these days to really help with the wording and I understand that's regularly used. But making sure that your authentic self comes through and that you are showing your passion for your career pathway.

Nick Bridge: If someone wasn't to get into a graduate program, what would you say to them?

Michelle Rutherford: Yeah. Gosh, it's so difficult, isn't it? And I have a huge sense of empathy for it's a bit like getting ATAR scores for university too. That same punctuation mark in people's lives that there's so much pressure and difficulty. So just to acknowledge that first, because it is tough. And my advice would be it's not the end of the road. It is that punctuation mark. And just like people who were interested in university, there's lots of different paths into university. There's lots of different paths into nursing and they might have one path in mind and be very passionate about that and that's great. But if that doesn't work, there are plan B, C, and D. 

There are other opportunities for you. And it might not be the path that you initially choose, but just be open, be open to looking at different things. If there is the opportunity to work rurally, for example, if they can move. Amazing learning opportunities in those environments and beautifully supportive teams. So, there are lots of great opportunities that might really open doors for the future into pathways that they are interested in.

Nick Bridge: Yeah. In your experience, Michelle, those who perhaps haven't got into a graduate program in their first application, who've come later on and been successful in getting into a later graduate program, have you noticed anything about, I guess, the time they've spent in that interim period about what they might have done that has helped them be successful in getting into a program? Is there anything specific that you've noted in your experience?

Michelle Rutherford: And it would just be anecdotal, to be honest. But I've seen people on applications have done short courses in particular areas that they wanted to get some more experiences. And there's the financial constraint. There's lots of free short courses as well that are available. Again, looking at that volunteer work and looking at work that aligns really closely with the areas they're interested in and really seeing people look at other postgraduate study that will complement the Bachelor or Master of Nursing as well. So there's a few different pathways I've seen. But one thing that you do see is that absolute passion and commitment come through in their application to succeed in their roles. And these are people that we really want to support for the future. They're our future workforce.

Nick Bridge: Yeah. Fantastic. Yeah. Good advice there. In your experience with early career nurses and graduates starting in an organisation, there's obviously not just the clinical challenge that is a challenge, and it's not just learning the processes and the policies and the practises and the environment that you begin to work in and then sort of trying to develop and hone your craft. There can be quite an emotional roller coaster starting full-time work, shift work, all those kinds of things, not seeing their friends, not being able to play the sport they used to play at the same time, availability. What are some of the well-being challenges that you see in what we just say to graduates who are trying to develop their career and function in a new workplace?

Michelle Rutherford: Yeah. Absolutely. I always liken the start of the graduate year to learning to drive a car, that you can look fundamentally at all of the different skills and you can practise the skills independently. But bringing everything together at first takes so much mental energy and it can be just mentally exhausting. And you'll find that you're overthinking things at times and you're having to actually, as you would with driving a car, you're having to think about, "Okay, I brake. I look in the rear-view mirror and then I brake, and then I put the indicator on and doing different things in different sequences" and eventually, it becomes more customary and you become more relaxed with your driving. I do feel that coming into the nursing profession, there's so many different things that they're needing to think of at the same time and needing to be aware of and looking out for and that is really tiring and can take its toll. And it's acknowledging that, but also being kind to themselves that eventually, they'll relax into the role, and it will get easier and some of that critical thinking and clinical reasoning starts to come through with experience, but that it's not something everything is very intentional to begin with. So, I think it's acknowledging that and helping them to understand why they're so tired because they'll see other nurses who have been working for many years come and go from their shifts and not look so tired. And I think that is a really big part of it is understanding the reason why and being kind to themselves about that.

Nick Bridge: You mentioned the fatigue of being in a new environment, being always on, having to learn constantly, being observed all the time, all that sort of stuff. And to be aware that, yeah, you're going to be tired and others around you might appear like they're coping pretty well, but they've got a lot more experience and exposure and fuel and knowledge. What other sort of well-being issues that new graduates should, I guess, be thinking about when they're starting? Things to expect or things that they might do, what you might promote to them in your organisation about how to go about starting and looking after yourself?

Michelle Rutherford: Yeah. I think the importance, and I discussed it earlier as well, the importance of that network and that friendship group, whether that's at work, outside of work, maybe hopefully both. So having like-minded people that understand your situation is actually really valuable because shift work is really a very different environment and your friends might be going out on Saturday night, but you've just worked a morning shift and you don't feel like it, or you're on the night duty and won't be able to join them. So having a bit of a mixture of networks and friendship groups that you can go to for support, but not just support for that well-being piece around just having hobbies, having things to do outside that are nothing to do with work, that actually fill your cup, really add to your life in a positive way so that you can actually have some time to be doing something different. That can be really helpful as well. 

And looking at what the health service offers in terms of well-being, because every health service offers a lot of different offerings. And we've got access to, obviously, the Nursing and Midwifery Health Program, but also looking at within the graduate programs, what well-being strategies they're offering as well. This is really a focus of graduate programs, in particular in Victoria, that we really want to make sure that graduates feel both well supported, but that well-being piece can be customised to what works for them and that they really find those tools that are really going to help them to recharge and reconnect outside of work as well.

Nick Bridge: That sort of leads me into a question I have in mind around the well-being strategies. And obviously, well-being is really important, not just in graduate year, but throughout your life and often, the focus is around clinical competence. Yes, clinical competence is really important, but there's this kind of element to clinical competence that's about building resilience too. And how would you reckon that graduates can work on building resilience and not feeling like they just have to tough it out in times that are difficult. What advice would you give them?

Michelle Rutherford: Talking early and seeking help early. I think that early intervention is the key ticket to making a difference. I think there's a lot of expectation, self-expectation, but expectation of others on them at that time. And I think identifying that they're not okay or that they're starting to feel more stress or starting to feel emotional when they go home and they're carrying things that they weren't expecting to carry home in their mind. It's really important to speak up early and seek help early and then early intervention can come in in terms of looking at strategies to support. They can talk with the education teams and their manager and their preceptors. What's working for you at the moment? What have you done in the past? And let's work on some strategies and actually intentionally put these in place to help you to continue successfully in your work.

Nick Bridge: I'm glad you mentioned that. I wanted to ask you, is there a role, a place for preceptors and the education team and managers in looking after the well-being, the psychological sort of safety of new graduates?

Michelle Rutherford: Oh, absolutely. I think we've all got a role in our team's well-being. We've got our own responsibilities in identifying what works for us, but when we're not well as well. But absolutely, we all have a role in that. I think it's really important that we look after each other in healthcare and that we can see in others when someone's not right. And I think that that's difficult for graduates because often they're coming in and people don't know what they're like outside of work and they haven't had a chance to get to know them yet. So it's really important that the graduate speaks up because once teams know or individuals know, if they just want one trusted individual, then I think it just makes all the difference to their experience. And it can be a shared experience that has been worked through together.

Nick Bridge: Really important, I reckon, to make connections, but also, I guess, be a bit vulnerable with some of those connections, at least, to help guide your journey. And I guess it's normal to feel abnormal when you're starting out in something.

Michelle Rutherford: Yeah. Absolutely.

Nick Bridge: And not to feel stressed and out of place and the fish out of water. Yeah. I'm really glad you mentioned that. If a new nursing student or a graduate was listening today and wondering whether they really belonged in the profession, what would you say to them?

Michelle Rutherford: Oh, I would say, "Of course you belong." But to be kind to yourself and give yourself some time. Sometimes it takes a while to feel that sense of belonging and I always say there's two types of belonging. There's belonging to a health service where you start to feel connected and coming to work and starting to feel proud of where you work and your identity in the workplace. But there's also that sense of belonging to the profession and I think with a few years of experience and really getting involved in the networks within the profession, the professional affiliations, those type of things, you can really build your professional muscle. And that sense of belonging really comes with that and to become passionate about both your workplace and your profession is really a gift and can become the passion that really brings you to work every day.

Nick Bridge: What a great note to finish on, Michelle. That's a really optimistic outlook on how to develop yourself and how to maintain yourself and, I guess, build your sense of, like you say, belonging in both your career and in your role as a healthcare professional. It would be a pleasure to come and work with you, I would suggest.

Michelle Rutherford: Oh, thank you.

Nick Bridge: I'll keep it to things you say. I really appreciate the time that you've given to us today, Michelle. Thank you very, very much.

Michelle Rutherford: Oh, my pleasure. Thanks, Nick.

Nick Bridge: Fantastic. For any nurse or midwife who might need support after today's podcast, you can access our service on 03 94157551 or visit our website at www.nmhp.org.au  Thank you for listening.