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New Grad RN Angst

  1. 49

    I've been working as a new grad RN for 6 months on the step down unit of a small community hospital. I am being crushed by the weight of my own self doubt. This is an article detailing the types of thoughts that go through the mind of (I hope, anyway) a typical new grad. My hope is that other new grads will see themselves in these words and not feel as though the feelings they are having are unusual or a reflection on their talents or potential.

    New Grad RN Angst

    Today is my day off after working three days in a row. However, my eyes popped open at 0530 and would not close again. My brain immediately went into review mode. Shoot! I forgot to give that detail in report! Did I do enough with that brand new admission? Should I have done more before handing over care? Did I miss anything with that patient who did not have a great urine output yesterday? My fellow new grad RN seemed so competent when she took that new ER admission. Do I seem that way to her?

    And on it goes. As a new grad RN on the step down unit of a small community hospital, I can make a full-time job out of worrying about my full-time job. Every day brings a fresh set of worries. I have been working six months now, and a new worry for me is that I am still worrying. Shouldn't I feel more competent and relaxed by now?

    Nursing school prepares you to take the NCLEX. It really does not prepare you for the reality of taking care of 5 acutely ill patients. I was lucky. My employer has a great new grad RN program, and I was gifted with 13 total weeks of orientation (2 weeks in the classroom, 11 weeks on the floor with a preceptor). This sounded like such a huge amount of time when I first started. It didn't seem near long enough when it was time for me to cut my ties with my preceptor and go it alone.

    I am a type A personality with OCD tendencies. I like things orderly and neat. Like Santa, I like to make a list and check it twice. I like to have a plan, and I like things to go as planned. The problem with all of this, of course, is that in nursing nothing ever goes as planned. Unexpected things happen all the time. And there is no TIME to make a list and check it twice. There are constant interruptions to your train of thought, and you just have to be able to roll with that. Veteran nurses may be able to roll with five patients all needing a long list of medication at the exact same time while simultaneously dealing with head-to-toe assessments, call bells, order changes, lab results, critical labs, telemetry monitoring, and charting, but this new grad nurse finds it overwhelming to say the least. On my best days, the stars align and I am able to whisk from room to room and get everything done in a timely manner. On my worst days, one or two patients can take most of my time while my other three are left to wonder where the heck their nurse is with their morning medications.

    For me, the crisis of confidence I am experiencing is the worst part of being a new grad. I am a person who came into nursing later in life (I was 39 when I graduated from nursing school). I have been successful at past vocations. I have a great work ethic and have always been considered a valued employee by past employers. I was successful in nursing school and graduated with the highest GPA in my nursing class. However, as a new grad I am constantly questioning my ability to do this job. I worry that I am annoying my coworkers with my seemingly endless stream of questions. I worry that I am annoying the hospitalists with my barrage of pages. I worry that I am not going to get any better at starting IVs. I worry that my patients are going to realize I have only performed whatever skill I am performing a few times before and that I will appear incompetent. I worry that my employer is secretly sorry they hired me. I worry that I am never going to feel more confident and improve my speed and efficiency, and then I worry that as a result I will never get to spend the time I would like with my patients, as I will always be rushing to the next thing, the next item on my mental list. Most importantly, I worry that no matter how hard I try, I am going to miss something and something bad is going to happen to one of my patients. I worry. I worry. I worry.

    In order to combat this incessant worrying, I find myself seeking constant reassurance from coworkers and fellow new grads. I hate to admit this, as it makes me sound callous, but I am comforted by the fact that my fellow new grad RN cries in the shower when she gets home. I am comforted when one of my nursing school classmates jokes, "Some days I want to drive my car into a tree on the way home." This makes me think that maybe my sobbing car rides home from work are not entirely out of the realm of normal. Coworkers in whom I have confided my feelings tell me that it will take a solid year before I feel like I know what I am doing. I find comfort in their words, but still I worry that I will be the exception.

    In the face of all of this constant worry and stress, all I can do is continue to try my hardest to be the best nurse I can be for my patients and not lose sight of the fact that I am working for them and only them. I will continue to hope that as long as I keep my patients and their safety and well-being foremost in my thoughts, the rest will fall into place, so that one day I will be the one saying to a terrified new grad RN, "Don't worry. Give it a year. You're doing well. You'll get it. Trust me. No, really. Trust me."
    Last edit by Joe V on Jan 21, '13
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  2. Visit danigold profile page

    About danigold

    I am a 40-year-old new nurse struggling to make it on the step down unit of a small community hospital.

    From 'Fredericksburg, VA, US'; Joined Jan '13; Posts: 8; Likes: 54.

    Read My Articles


  3. Visit  SarahLeeRN profile page
    #1 3
    This is a very good article! I think that you packaged and wrapped the feelings of a new grad RN very well. It was a reminder to me of how I felt when I was brand new. I think everyone who has been a nurse has felt this way starting out. (If they say they never did they are probably either lying, incompetent or both *gasp*
    Even after being a RN for awhile there are still moments of worry, stress and self doubt. Focus on the good, hang on and pray through the bad and you will get there.
    I once asked a nurse I respected "Do you think that I'm smart?" when I was having a self doubt mini crisis after a really long and crazy shift. She replied as a matter of fact "Of course you are smart. Anyone who makes it through nursing school is smart. You just need a little more experience." And that was just the encouragement that I needed. We did make it through nursing school, even though that seems so long ago..
    You ARE a RN, You ARE a good nurse and you ARE making it! I wish you all the best!
  4. Visit  PacoUSA profile page
    #2 4
    We are the same age and have the same time in the profession. I agree with you 100% on your feelings. I too feel overwhelmed still, but trusting that it all gets easier. Just think: we are better off now than we were 6 months ago
  5. Visit  Esme12 profile page
    #3 24
    ((HUGS)) you are perfectly normal.....I always share my brainsheets....a collection of ways to keep organized for the use of AN members only...they are a collection from other AN members (daytonite) over the years. feel free to modify them

    here are a few.

    1 patient float.doc‎
    5 pt. shift.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    i hope they help
  6. Visit  Intentional profile page
    #4 0
    Great article! Keep it up
  7. Visit  nurseGi profile page
    #5 2
    I am a new grad on orientation right now and I am heading to my 5th week on to the floor. The first 3 weeks of my orientation were in classroom. I am totally overwhelmed, and I get what you mean about "worrying" i worry about everything.. all day. Last week I met with my nurse manager and educator and they told me they are switching me back to 8hr shifts for a couple weeks because I am not where I should be at right now during this time or orientation and that the 8 hr shifts will provide me with more experience since will be going everyday. I left the meeting shocked, upset, and most of all WORRIED about my job. I go home crying atleast twice a week after work, being a new grad is hard.. I also feel like i am annoying my coworkers, preceptors, and worry everyday (especialy after the meeting i had) that they regret hiring me. I had a nice 3 day weekend and I am working tomorrow and sunday, and I am scared/nervous to go because i feel like i am really being watched and judged about whether they are going to keep me or not. You are SO right when you say that nursing school just teaches you the basics, I only have been on the floor for a month and Im still not sure about things and need reassurance from my preceptor, im not sure where they expect you to be after one month. This is nerve-racking, I love nursing.. but i am scared.
  8. Visit  tanna898 profile page
    #6 5
    Quote from Esme12
    ((HUGS)) you are perfectly normal.....I always share my brainsheets....a collection of ways to keep organized for the use of AN members only...they are a collection from other AN members (daytonite) over the years. feel free to modify them

    here are a few.

    1 patient float.doc‎
    5 pt. shift.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    i hope they help
    Thank you for this information. I dearly miss Daytonite
    Last edit by tanna898 on Jan 18, '13 : Reason: Forgot quote
  9. Visit  owlRN01 profile page
    #7 0
    I feel that exact same way! Great post I can't wait until I feel more comfortable with the job!
  10. Visit  M/B-RN profile page
    #8 1
    I totally agree with you that the horrible worries of other new grads make me feel better! I'm glad other people cry and want to die so they never have to go back to work because some days that is how I feel too LOL

    I decided that I am giving myself a year before I decide to write off nursing for good and go back to school for something else.
  11. Visit  nsdoyle620 profile page
    #9 1
    I am a new nurse as well. I've been working nearly four months. I can relate to this post so much. I work LTC nights and I have a 60 pt load, i'm not able to see every single person in my shift and I worry I missed something. Sometimes I have a hard time sleeping cause I go over every detail of my shift hoping that I didn't miss something critical or leave the day shift with things that should have been done. You're not alone!
  12. Visit  08RNGrad profile page
    #10 5
    That was so me when I first started, the constant replays!! The only difference in my brainsheets is I would divide my piece of paper into 1/4's so I could capture 4 patients per side of paper, so I would have report sheet big enough for 8 pts on 1 sheet. This way I could keep this 1 sheet of paper in my scrub top pocket. I would just put basics on, name, allergies, dx, procedures for the day, critical lows and highs and key labs for the day, times meds due, etc. BASICS, things to prompt me throughout the day and to give a good report. My preceptor taught me this and it really helped me out. It helped me from feeling like I had to check and double check constantly. It was also a nice way to keep track of questions i had for MDs as they came through during the day. They would often be there for a moment, so I had to have everything organized to grab them quickly before they left! Brain sheets are KEY, they help so much b/c once everything is check off, you know everything has been completed. Good luck to you!!
  13. Visit  FLfemale profile page
    #11 0
    I've been reading these posts with great interest because I'm thinking about applying for the RN program. I've been a dental hygienist for the past 20 yrs but the market is overrun with unemployed or under-employed RDHs. I can't even get a call back, let alone an interview. Oh sure, I could work for a clinic but they're basically factories & I would burn out fast. There's something about pushing unnecessary dental work & pricy gadgets for a commission that goes against my ethics. I figured with my A.S. degree I could go for nursing but I do have my doubts. It sounds like a snakepit out there. How are the RN opportunities, esp for new grads, Tampa Bay area in FL? Any responses will be appreciated.
  14. Visit  Isitpossible profile page
    #12 1
    WOW!! thanks so much for writing this. As a new nurse, I can totally relate to the constant worry, stress that Im not competent. I always feel Im missing something, did I give every detail in report, did I document correctly.. Oh the list goes on and on...