15 Things I Wish I Knew as a New Grad Nurse

One year ago, I began as a baby nurse, every fiber of my being laden with trepidation and excitement. I pulled up my compression socks, laced up my promisingly supportive Brooke’s ghost shoes and stepped foot into the hardest year of my life. I didn’t think anything could be more challenging than nursing school, and I was in for a rude awakening. Everyone says the first year of nursing is the most challenging, but it’s hard to grasp until you are in the throws of the anxiety, incompetence, and fear that plague your every day. There are a few things I wish I had known or someone had told me before I began this year, and maybe, just maybe, this can help some new grad nurse out there on this emotional, wild, and spectacular rollercoaster.

  1. You will make mistakes. For some reason, I didn’t realize that as a new grad nurse, you make mistakes. No one ever said point-blank, buckle up, you’re gonna screw up…. a lot. Maybe people don’t talk about it because we have people’s lives in our hands, and we should strive for perfection. This is true, but I think it would have saved me much of the intense self- badgering if I realized mistakes were inevitable. Don’t get me wrong– always triple check your meds, doctors orders, operate in professionalism, always do your absolute best….. but every little mistake from having an overdue med due to mismanaged time (IT WILL HAPPEN) to forgetting to unclamp your piggyback antibiotic (everyone has done it) to not charting something correctly is an opportunity. Never try to cover it up, make sure your patient is safe first and foremost, and then… learn. Trust me.. you won’t make that mistake again. Do not beat yourself up. Repeat after me… Mistakes= Lessons, Lessons= Growth. You need the mistakes to grow, and each mistake is molding you into a strong, robust, competent nurse. The mistakes will become fewer and farther between, but they never will entirely cease. Neither will the lessons, and neither will the growth.
  2. You will experience a new level of anxiety, but it will get better. Every single day I stepped onto the floor, the anxiety overwhelmed me in a way I have never experienced before; it plagued the crevices of my mind and soul. I felt like I was operating in flight and fight at work AND at home. I couldn’t separate the two, and would often wake up in hot sweats- “Did I return that med?! Did I chart that?! Oh shoot, I forgot to get that patient ice chips!”… I had literal breaks with reality. One time I woke in the middle of the night panicked because I thought I had forgotten to give my husband insulin (he’s not diabetic). But somewhere along the line, I was able to turn the “work” brain off. It took a long time, but now a year later even though I still think about my shifts, it doesn’t carry the same anxiety provoking reflection it did at the beginning. I still shed plenty of tears for my patients on the way home or the next day after a hard stretch of days, but it’s out of mourning for and with them… not from anxiety.
  3. Those impossible skills…. become possible. One of the most frustrating parts of being is a new grad is the lack of agility and the constipated pace of your skills. Tasks that are super “easy” to most seasoned nurses still scare the code brown out of us. Even priming IV tubing seemed like a formidable obstacle when I began (air- in-line alerts sent me straight into cardiac arrest). By the end of the year you will be taking out central lines, hanging blood, straight cathing, and working with PEGs/trachs like it ain’t no thang. Hands on skills were my weakness, I didn’t think I’d ever get the hang of it. But somewhere along the way, I did. And trust me, if I can do it, you can do it.
  4. 12 hour shifts are long, but nursing is a 24-7 job. One thing that I didn’t quite get when I began is nursing is a 24-7 job. Yes, in those 12 hours that belong to you, the weight of people’s lives are in your hands. But always remember— it’s a 24-7 job. Do your best not to pass on any tasks, make sure you give all your shift meds, but if you don’t get around to changing the now expired IV tubing because your patient was physiologically unhinged and you were keeping them from grave, it’s ok. I used to think I literally would get fired if every single little protocol ridden task was not completed. Some days, all you can do it keep someone alive. It’s a 24-7 job. Just remember that.
  5. Yes, you can do another day. Countless times I thought to myself, I don’t know how I can do another day of this. Sometimes we have such a bad first shift in a stretch of three, and we don’t know how we can physically or emotionally handle the next two. But you do. You just do. After enough times of thinking this, and enough times of doing that “next” shift, you start to know that you can, in fact, do another day.
  6. Listen to your patients! Sometimes symptoms are not textbook clear. If a patient says they feel “off”, listen to them, closely. What is off? When did it start? Listen to their concerns, even if they seem unwarranted, because often times they are not. There are clues in conversation, history, and in chats with family that may not show up in vital signs.
  7. Patients listen to you, closely. Patients will ask you so. many. questions. Sure, you may know some, but there are plenty you will have no clue. Do not be afraid to say, “I don’t know, but let me find out!” or direct the question to the proper team. Something I have discovered is when you have those scrubs on, patients take you at your word. Even if you put a disclaimer- such as I’m not 100% sure- or, make sure that’s ok with your primary doctor, or “I think _____” but double check with your pharmacy….. they will only hear the answer part of your statement. Avoid saying those disclaimer statements, because as soon as it is out of your mouth, they will hear my nurse said ____ and take it as truth. It’s better to utilize your resources (call pharmacy, ask your charge, ask the MD) and give them the most informed answer possible.
  8. Listen to your gut. “What gut?” you may be thinking as you have only been a nurse for about a month. Ok, your gut will develop as time goes on (and I’m not just talking from break room potlucks and donuts). If you have that “bad” feeling… investigate why. There are so many times I wish I had just listened to my gut a bit more. Just last week I had a patient who I had a off feeling about. Nothing had changed in their baseline neuro exam or technically by physiological assessment. But I knew something wasn’t quite right. I told the MD, but he had no real basis to conduct any additional tests either. I told the next shift nurse about this feeling too… and the next day when I returned this man was in the ICU. Trust. your. gut.
  9. Nursing Assistants are vitally important. Y’all. I don’t think I understood just how important nursing assistants are before starting this gig. They are massively crucial to our success and the patients’ success. The nursing assistants on my floor are brilliant, many have been working for years and single-handedly keep me afloat some days. I learned (and continue to learn) a tremendous amount from them. Do not be afraid to ask them for their tips/tricks in patient care.
  10. “Thank you” goes a long way. This may seem elementary, but as a nurse, you begin to understand the weight and gravity of a thank you. Give thank-yous out like candy. They are free to give and priceless to receive. Thank your housekeeping staff, your charge nurse, your transporter, your nursing assistants, the previous nurse who tried her best to get loose ends tied up for you, doctor’s, PT/OT who helped your patient walk for the first time since surgery. We are a family in healthcare, and it’s so important to remind them they are all appreciated.
  11. Make recommendations, and happily accept constructive criticism in return. ISBAR- the “R” (for recommendation in communication) is especially hard for a new nurse, but do it anyways. You will get some MDs who will make you feel as if your idea is the worst possible idea they have ever heard. You will also have others who will kindly suggest an alternative. And EVEN some who will accept your recommendation. Regardless of the response, ask them to explain the reason behind the intervention/order/medication, and then thank them for taking the time to explain. It will go a long way in developing rapport among you and the provider.
  12. Go the extra mile. Cue the eye rolls from my nurses in the back. I get it, we already are given an impossible to-do list every day. There is no way to go the “extra mile”. Or is there? When I first began, I barely saw my patient. I only saw the to-do list. I barely had time to be with them, because I was just trying to get it all done. Yes, this is the way of nursing now it seems, but sometimes, just taking the tiny extra seconds to hold their hand and say, “How are you” at the beginning of a shift or offering an extra pillow can make all the difference. This one takes time to conquer, but you’ll get there. I am still learning how to do this, and it takes reminding myself daily to just look the patient in the eye and not just to examine their pupils.
  13. ASK ALL THE QUESTIONS. Not sure how I didn’t have this listed as number one… but ask every question. Do not assume ANYTHING. You will feel like you are grating the nerves of some other nurses, but you will learn who your best resources are. Remember, a little annoyance is nothing in comparison to someone’s life. Even the slightest bit of doubt, check it out!
  14. ‘You time’ is necessary time! “On the clock” for us is a fight of life vs. death. When you are off the clock embrace your life- do what you need to do to take care of you. Go for a walk outdoors, exercise, do yoga, pray, write a letter to your friend who lives far away, get a massage (get multiple massages), pedicures, go out for a nice dinner, nourish your body with healthy foods (and nourish your soul with dessert), travel, or do nothing at all. Find what helps you relax and disconnect. I didn’t want to be social at all for a good six months and found myself in a hole of isolation and depression. I didn’t think I had the energy to do anything. But once I started making plans, planning trips, etc. things started turning around quite a bit. Find what works for you!
  15. It’s worth it. Oh my sweet fellow baby nurse, you don’t know if you will survive, but you will. I know it’s hard to believe, but things will get better. People would say that, and I just didn’t believe them. Have faith. You are stronger than you think. This year, yes it is hard, it’s probably the hardest thing you have ever done, but it’s worth it. When you see your competence start blooming, so will your confidence. When a patient tells you that they will never forget you, it’s the most rewarding feeling in the world. Through this whole process you are impacting countless lives and countless lives will impact yours. Soon you will have forever-in-your-heart moments, unforgettable connections to patients, and “good” days under your belt, or stethoscope rather. Write them down and remember them. Because at the end of the long twelve hour shift day, there is no amount of fear, anxiety, or bad days that can overshadow the honor it is to save a life.

Go get em, Rockstar! You’ve got this!

Ohh, and never use the “Q” word. Never, ever, ever use the “Q” word.

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