New Grad RN Angst

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. Nurses Announcements Archive Article


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."

Thank you for sharing this!

I am in a very similar situation. I had another career for 20 years before switching to nursing. In my other life, I felt competent, even something of an expert. Now, gone. This post and the comments sum up my feelings completely. There are days when I kind of feel like I am getting it together, and then days where I'm there until 9pm trying to finish charting and getting attitude from the night shift because I couldn't get to something. My problem though is I think I spend too much time with my patients. My patients love me, at least that's what my director says, but I never get out on time. Looking forward to the day when I truly have it together.

Why did you leave your former career? Bored? Fired? Pursueing a passion? I've always admired the competence & dedication of hard working nurses but never wanted to be one myself. I love being a RDH because of the normal work days & hrs AND I feel very competent with my skills. My patients love me due to my gentle but very thorough cleanings. But, I lost 1 of my jobs which leaves me working only 1 day a week. I can't afford to live on that & I'm too young to retire (53). This has lead to me think I should go for RN although the thought of working in a hospital terrifies me. All I read about is the chronic overload of work, understaffing & other issues......enough stress to cause RNs try cry in dispair & regret ever becoming one. YIKES! What about working in a small private office, clinic, surgery center, etc? Is the stress level more managable? But is it hard to get in a place like that? Please give me some insight.

Specializes in Infusion Nursing, Home Health Infusion.

I know it is difficult,not only have I been through it, I continue to witness it. I would try to STOP worrying so much as that will get you nowhere and drain your energy. Everytime you start to ruminate or worry about something literally do some thought stopping in your mind. Replace it with what i could have done differently?....what did I need to look up or or study?.....Can I fix my worksheet so I will be more organized? Then do it and let it go! You have what it takes to be a success and if you continue to learn and substitute education and learning and a plan instead or worring you will do just fine!

Specializes in ICU + Infection Prevention.

5 stepdown patients? Nights? What is the CNA to patient ratio?

5 seems like a lot when I see most places around here 1:4 to 1:8 for floor patients and 1:3 to 1:4 for stepdown! (with 1:8-1:12 CNA)

I feel the same way!

Specializes in NICU.

I felt exactly the same way six months into my career, and sometimes, to be honest, I still feel that way. I feel that way without the crying and the dread of feeling completely overwhelmed, but sometimes I still go home and wonder what more I could have done. Then I think, "You know what? I only peed once this shift and ate my lunch in 5 minutes. If that's not giving it my all, I don't know what is." Something that helped me realize how far I'd come: when the fresh new grads start rolling in. You've been a nurse six months... assuming you got a job fairly quickly after graduating, the graduates from December will starting working. There is a satisfaction when you're able to answer their questions, after all, you have six months more experience than they have! You will see how they may depend on your expertise and it makes you feel like you actually know something.

It sounds like you're doing a great job. Never stop asking questions or wondering if you can be better. I think that's what makes you a fantastic nurse - you will always strive for excellence. Your patients are very lucky.

Always remember: Every nurse was once a new graduate, and every preceptor was once a novice. One does not acquire greatness in nursing care of patients through osmosis of years only; if that was the case, EVERY nurse would eventually become a great nurse. Rather, one who brings the necessary characteristic of caring of people is ALREADY great; nursing is just the practice through which that characteristic is fully deployed. Your underlying reasons for your angst demonstrate that you care about your patients; thus, you are already great. Be patient, your nursing practice will catch up to you. (From a RN over 15 years)

OMG Thank you so much for writing this article. I graduated nursing school in October, passed my NCLEX in December and am starting in a New Grad RN program in the ED in March. It's been a whirlwind of events and I'm still trying to grasp that I am a licensed nurse with a job! I was expecting to be searching for a job for months and months. I basically got lucky with the timing. Applied online, and then saw them at a career fair where I was able to give them my resume and ask them to look for my application. I got a call a week later to come in for an interview. Anyways, since I passed the NCLEX, went through the interview process, and was offered this job- I've been FREAKING OUT. Everything you talked about in your article I've been worrying about. But I haven't even started the job! One of my professors once talked about a syndrome New Grad's have: "Imposter Syndrome" We feel like we don't belong and are posing for something that we're not. I definitely feel like that. I worked as a server through nursing school and I sometimes had "serving nightmares" where I would wake up and wonder if I forgot to bring one of my tables a refill or if I forgot to put in an order. Those nightmares are the worst and it's only food service!! I can only imagine how they'll play out when work starts. I so appreciate you're transparent honesty, it gives me courage to go into this New Grad Program not afraid to ask all the questions I need to ask to be confident in my abilities. You sound like an awesome nurse btw!!! :) Thank you so much!!!

Specializes in open hearts post op.

If your going to survive in this profession make sure you learn how to prioritize. Do the best you can to keep your pt's safe. Use your nursing judgement and always be slightly paranoid.


I could have written this myself! I feel EXACTLY the same way! The anxiety is killer and I truly feel I am by biggest critic and ultimately my biggest enemy. I am glad I am not alone with these feelings. I have terrible post-shift anxiety ("omg, did I chart that?" "should I have done this?" "Did I give that med" etc) It drives me crazy...or should I say, I drive me crazy!?

I hope the anxieties go away somewhat, because I feel that they are so prominent in my head that I am unable to think properly. And of course being in the right mind-set is necessary for our jobs so we can properly care for our patients!

As bad as I feel for you after reading this, this really did make me feel better and I hope you feel better too knowing from all these responses that you are not alone! All the best:)

WOW! Thanks to everyone for taking the time to comment! Just reading them has made me feel so much better. It really does help to know that my feelings are not that unusual in the grand scheme of things!