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."

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!

You definitely strike a chord in me and, I imagine, in most new nurses. My program was unique in that we had a clinical coach that we would work full shifts with all year. I was taking on full care of only 3 of her 4 patients on a step down cardiac unit and became really overwhelmed. I straight up told her, "maybe I'm just not cut out for this". She responded by saying, "no one really is. The demands are unreasonable for any one person, and even after 28 years I still struggle at times to keep up with everything." The takeaways were that we can only do our best, reach out for help when we need it, and that YES this is an incredibly difficult but rewarding job!

Specializes in critical care.

One of the best articles I've read on here in a long time. Good job!!

I'm a new grad in month 4 of my 6 month ICU orientation, and dreading the day I lose the safety net of my preceptor.

Specializes in Corrections.

Wow, It was like the little voice in my head jumped out and wrote this article. I to am in constant motion of thoughts and worrying. And I too was one of the top of my class and have OCD, everything in it's place and a place for everything. Every "i" dotted and "t" crossed. Sometimes it just seems impossible to do that. I'm at 4 months now in, and my doctor has suggested Prozac. LOL. At least something to help me get through this first year! Good Luck, keep your head up and I'm sure you are doing great, as I hope I am.

I'm getting ready to start my first job and everything you mentioned is going through my head....... Thanks for making me realize I'm not alone!

Love the article! Im a new nurse as well and I just started my first job. Im currently still on orientation and after every shift Im scared I made a mistake or that my coworkers think I'm an incompetent. It really is nice to know that Im not alone and these feeling are normal. Good luck to everyone! and heres hoping the feeling of confidence soon replaces the feeling of worry.

I have some suggestions as to how you can deal with your disabling anxiety. I would speak to your manager for guidance (areas for improvement etc), speak to your Employee Assistance Program (EAP) if you have one, take some quiet time for reflection or journaling after each shift. Focus on "quiet" time not hand ringing, tears, worries, but rather on the positives. Initially try and come up with 5 positive things from your shift--at first it will seem difficult, and then increase to 10 positive things. Take pride in the small things and then the big things won't seem so difficult.

I have worked on night shift since I began as a new nurse 5 years ago and I think it is the best shift for new grads because you don't have to deal with therapy, meals, surgeries, procedures, families, doctors, etc. Night shift is busy, don't get me wrong, but their is more oppurtunities to ask questions, seek out advice, and take a second to think before you act--instead of reacting. If you could change shifts and soley deal with medical/surgical problems instead of all of the chaos that can be a hospital floor--perhaps you will feel more confident.

One thing you need to stop is holding yourself up to this nonexistent saint of a Florence Nightengale nurse--people make mistakes, no one is perfect, no one else is floating through their shift without worries and concerns--they are just not ruled by them. Let your critical thinking rule your decisions--not your fears and worries. Please seek help, and make changes soon before you are truly frozen by fears and you can't function AT ALL as a nurse--we all need you out there.

Specializes in Public Health Nurse.
FLfemale said:
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.

I am in Florida, South Florida to be more exact. I graduated last April and took my boards on August. Been looking for a job ever since. I have only gotten 2 interviews and only as a favor to my friends. No one wants new graduates in this area. We have over 13 nursing schools graduating nurses twice a year. No shortage here and gets not better in other counties. Today, I was thinking if I should even bother continuing with my BSN or switch to another career.

Specializes in critical care.
take some quiet time for reflection or journaling after each shift. Focus on "quiet" time not hand ringing, tears, worries, but rather on the positives. Initially try and come up with 5 positive things from your shift--at first it will seem difficult, and then increase to 10 positive things. Take pride in the small things and then the big things won't seem so difficult.

This is a great suggestion. I found journaling to be extremely helpful. Not only does it help you see the positives, but when you write down the things you want to improve on, it's easier to stop dwelling on them. It changes your outlook from, "I should have done better. I'm a terrible nurse and I will never get this right..." to "This is where I need improvement and this is my plan to make that happen." It's very empowering!

Specializes in Hospice, Case Mgt., RN Consultant, ICU.

Thank you for sharing your feelings. You write very well. I could not read all the responses so I jumped to the end. I am concerned for you. I began to feel anxious for you. I am afraid you will burn out if you continue beating up yourself every moment of the day! I agree with the suggestions to talk with someone and to journal. Also, I would suggest listening to relaxation tapes daily. You need to care for yourself as well as you do for your patients! Do you exercise? Going for a walk in your neighborhood or local park could help you relax. Try yoga and tai chi!

In the business world there is a saying 'Fake it til you make it!' Even if you don't yet feel confident begin to act as though you do! Otherwise, your anxiety will begin to rub off on your co-workers and your patients. Obviously you are a compentent nurse or you would still be working with a preceptor. You also have the knowledge, but you can not expect to know everything about nursing. When I worked in ICU/CCU I expected to learn something new everyday!

Wishing you peace of mind! Write us again in three months to tell us how you are progressing!

This post about stress and worry is so me. I have been into my career now for six months, and I still feel like I know nothing. I still am constantly asking questions. I am such a worry wort. I still do not feel comfortable some times. I just hope by the time my year has come I will feel more confident. There are nights that I just want to leave and never go back to nursing. I hope it gets better with time. Thank you Esme12 for posting those sheets. I plan on using some of them.

Specializes in Wilderness Medicine, ICU, Adult Ed..

Been there.

Done that.

Seen the movie and worn the t-shirt.

The doubts. The bad dreams. The no dreams because you cannot fall asleep even though you are so exhausted that you are barely able to drive yourself home. The tears (yeah, big, strong, macho men in nursing shed those tears too, take my word on that). Most of all, The Question lurking in the back of your mind; the question that you did not write in your post, because it scares you, but that all of us know haunts you: "is there something wrong with me?" "Is it my fault?"

There is nothing wrong with you. You are learning to cope with the pressure of having a job that matters. That is what you wanted, isn't it; a job that matters? You could have been a successful member of our nation's burgeoning fast-food industry, but you wanted more. You wanted to matter. Good for you! You are "paying your dues" to earn the right to do work that matters, just like all of us had to.

You will never stop feeling the pressure to be your best, nor should you. However, one day, maybe soon, maybe later, you will realize that no matter how hard you try to be the best nurse in the world, you never will be. Then, you will be able to understand that you do not need to be "that nurse" because being the best Danigold, R.N. in the world is good enough. Really Danigold, it will be enough. Trust me and the others who have posted. Trust what we are writing to you, until you are able to trust yourself.

"Courage is being scared to death, and saddling up anyway." John Wayne, I think.

I feel the same way. I and a new grad that has been working for 4 months now in a very a busy and fast paced med/surg telemetry unit at a big hospital. I feel overwhelmed everyday, after 4 months I don't feel any more confident. I had a meeting with my manager and was told they will not let me off orientation yet because they don't feel confident that I can handle an emergency. I'm afraid I'm going to get fired as well and I relocated for this job. I was also told that I should have been off orientation a month ago and they are giving me 2 more weeks. I'm stressed every day and don't even look forward going to work any more because I feel like I'm a huge disappointment to them. I work hard everyday too but it doesn't feel like a good fit for me. Thinking now maybe I should have started out in a skilled nursing facility.