How Will They Learn?

E very day, she woke up with a sense of dread. Driving to the hospital, she would feel queasy as she began to think about the hours ahead. Would she be able to complete everything that needed to be done during her long shift? Would she have the knowledge and judgment she needed? Her mind would race through several potential disaster scenarios; she wondered if today would be the day that she might harm a patient, perhaps fatally. Terror was never far away. The drive home was not any better. It usually involved a review of the mistakes caught just in time—the near misses. She reviewed diagnoses that she had felt uncertain about, medications she had looked up but already forgotten, and technology that had baffled her. She reviewed conversations, some with colleagues and some with family members, and wished she had said something different, or just had more time to listen and to consider what she was saying. It was an excruciating time in her new career as a nurse. This is how a new graduate described her first 6 months of working as a nurse to us. She is an extremely talented woman who had worked as a microbiologist in a research laboratory for 10 years before choosing nursing as a career. She graduated from an accelerated nursing program designed for men and women who already had earned a college degree. The program was excellent, but she still felt incredibly poorly prepared for the clinical responsibilities that she assumed as a staff nurse in a large academic medical center. Even though she was not yet caring for patients in the intensive care unit, her ultimate career goal, patients on the general medicalsurgical service where she worked were extremely ill and required close monitoring.