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So, you’re a new nurse. Now what?

Image: OJO Images Photography | Veer

I got a request for a post about role confusion (that awful feeling that comes from being a new nurse), and it sounded like a good idea. The transition from student to preceptored nurse isn’t as hard as you’d think; you still have to show up on time for various classes and lectures, you still have somebody following you around, you still feel like there’s some leeway for mistakes.

Coming off a preceptorship, though, is a whole other deal. All of a sudden, you’re a Nurse. But you don’t feel like one; instead, you feel like some schmuck who’s been picked up off the street and dumped into scrubs. Things seem really, really hard—even simple things, like a focused assessment of a patient.

Here’s what I learned when I was a new, nervous nurse:

1. You will not kill anybody.

Unless you do something spectacularly idiotic, which is very, very, very rare, you will not kill anyone. You have people looking out for you—this is true throughout your nursing career—and every action you’re expected to take has gone through a number of people more experienced than you.

2. Remember the First Rule of Nursing: If you have to jack with it, it’s wrong.

That one little rule will save you every time. Hospital and clinic work has been streamlined and perfected over the years so that it’s practically tired-new-nurse proof. Therefore, if you find yourself having to improvise or make things up to get something done, take a good look at what you’re doing. The likelihood is that you’re either doing the right thing wrong or the wrong thing altogether.

3. If you do screw up, report it immediately.

Nobody is going to fire you, yell at you or make you feel like an idiot. (Chances are you’ll do that last one to yourself.) Everybody, even Super Nurse Extraordinaire, makes mistakes every day. That’s why we have procedures in place to, say, double-check settings on pumps and so on. If you screw up, it’s important to report it so you can have help figuring out why you screwed up and how to manage the situation in the future.

4. Ask questions.

Everybody asks questions, including Super Nurse Extraordinaire. Most of us ask them constantly. We all double-check each other, help each other out with weird titrations, give second opinions on whether or not that patient is more or less gorked than the day before. Your colleagues are part of a team that includes doctors and other nurses and X-ray techs and respiratory folks. Ask ’em all questions. If anybody tries to make you feel stupid, respond politely and be effusively thankful. That’ll embarrass them to no end.

5. Honesty is the best policy.

If a patient asks you how long you’ve been a nurse, be honest. You’re not fooling anybody. If you don’t know something, say so, then vow to find out the answer. This, too, happens every day.

6. Don’t volunteer information.

I say this not because patients are stupid or mean. I say this because if you give somebody too much information, it can be truly overwhelming. Stick to answering the questions you’re asked, like “How long until I can shampoo?” or “When will my stitches come out?” Don’t go into a dissertation on possible side effects that only occur in 0.1% of the population. This is a lesson I learned the hard, hard way.

7. Fake it.

Act confident and friendly, even if fear makes you want to throw up and pass out. Eventually you will feel confident and friendly. In the meantime, nobody else will have to deal with your vomit or prone body.

8. Going home in tears is not necessarily a bad sign.

You will be so overwhelmed, stressed out and exhausted that you will occasionally sag against the wall of the elevator and weep. This is a normal part of the stress that comes with being a nurse. It becomes less frequent as you learn more. It’s okay. Here, have a cookie.

9. People will occasionally do mean things or be inappropriate with you.

Wackos can smell a new nurse. I got odd suggestions, inappropriate physical contact and outright bullying more in the first six months I was a nurse than in the next three and a half years. Be patient. Eventually you will develop that Nurse Callus that allows you to see the loonies coming and deal with them. In the meantime, lean on your charge nurse and your colleagues to help you get out of rooms unscathed. And if you’re getting consistently shitty assignments with a higher-than-normal proportion of weirdos, complain. It’s not fair to saddle the newbie with all of the nut jobs.

10. You will someday feel like a nurse.

I remember when that happened. I’d had a day during which I had made only a couple of minor mistakes, caught them before they’d done any harm and had caught a problem before it developed into something severe. Further, I’d had time to pee and eat and actually take time with my patients.

That didn’t happen until I’d been a nurse for more than a year—maybe even more than two. I don’t remember the exact date, but I do remember the feeling. It was as though I had finally gotten the hang of swimming with the current.

This will happen to you, too. I can’t stress that strongly enough. Nursing is a constant learning process. You feel off balance every day of your professional life, and there’s always something you don’t know. Nevertheless, there will come a day when you realize that you’re looking ahead of what’s immediately in front of you, and when care plans finally begin to make sense. You’ll build on skills you already have when it comes time to learn something new. Yeah, you’ll screw up royally the next day and go home in tears, but you’ll have had that one day when you could say, honestly, “I am a nurse.”

And then, a few years down the line, you’ll be chatting with a notoriously hard-assed doctor and apologize for doing something dumb, like calling her at 3 a.m., and she’ll say, “Y’know, if it comes from a good nurse, I don’t really mind it when I get called at 3 a.m.” And she’ll smile, and you’ll know that Good Nurse = You.

This post originally appeared in The Head Nurse blog.

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5 Responses to So, you’re a new nurse. Now what?

  1. Marianne

    Love this article. I’m graduating in December and am very nervous about feeling/being incompetent. This article makes me feel that I can be a good nurse and these feelings are normal and ok. Thank you for posting it!

  2. Everything about the entire process of becoming a nurse, is a one-day-at-a-time kinda thing. I have another two semesters to go before graduating and I can say this, unless you want it bad enough, you’ll NEVER make it. And those who do, are in a class all of their own!

  3. Cindy

    While I’m continually told that experienced nurses don’t “eat their young” anymore; it does happen and always with the same nurses. I have been on the receiving end as well as the other new nurses on the floor. When we compare notes, it is the same 3 day nurses again and again. We’re told to ignore them, but it’s impossible when their poison is directed at you.

  4. Resi

    i really love this article! i’m a new graduate and once i get a job, i know i’m going to be looking for this article again because i know there will be times i will feel so incompetent! thank you for the words of encouragement!

  5. SissyChezzy

    i read this over and over and over every time i get a little scared of going to work as a CNA. i am only a CNA and i am already scared of furthering my education to become a LPN/LVN. I am wondering if i am good enough to be a nurse? scares me day and night because what if i dont know what to look for or what if i fudge up and do it wrong… gosh so stress out but i’ll get over it as long as i read this post.:) good luck everyone and i wish you all the besties.

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