Were you ready? After more than four years of classes and clinical training, did you feel prepared for the real world of nursing?

Like any other graduate, you probably were anxious to prove yourself in the workplace; but did you feel like you had the proper experience? Were you surprised at the number of patients you were supposed to care for, or the acuity of their conditions?

Were you put off by doctors who dismissed you as a neophyte or patients who used you to vent their frustration at the health care system? Or were you stymied by managers who questioned your work ethic?

These are some of the reasons why new nurses quit. Nursing educators and administrators are trying to find ways to make nurses stay. While the old way may have been learning on the job, today's graduates must hit the ground running - patients are much sicker and nurses are expected to carry a heavier load right from the start.

Making the most of the education available in school can go a long way toward greater job satisfaction and fewer unpleasant surprises. Nursing students should explore programs like nurse externships, which give them real-world experience under the tutelage of a nurse preceptor. This is beyond a regular clinical rotation, and if it's a good program, a lot meatier.

After graduation, nurses should choose their work environment carefully. Does it support continued training and learning for its employees? It's important to keep your skill levels sharp - no matter whether you're a new nurse or a seasoned veteran.

Job satisfaction also is measured by how well you "play with others." Veteran and new nurses need to help each other, not butt heads over work philosophies.

"Once they are in the workplace, there has to be a bridge of understanding between the older nurses and the newer nurses," said Dr. Barbara Woodring, associate dean of nursing at the University of Alabama-Birmingham. "This is the Nintendo generation, where they expect a new sound bite every four seconds and they're not going to read a policy manual that's four inches thick.

"At the same time, you can take aside the new grads and show them that this is where you are coming from."

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