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."

Specializes in Wilderness Medicine, ICU, Adult Ed..
dpb425 said:
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.

Whatever happens in two weeks, do not think that you are a failure. If this job is beyond what you can handle today, it just means that you will have to change course until, in the future, you are ready for a job like this. I am not saying that you will have to look for another job, all I am saying is that there will be many unexpected curves in the road ahead of you, and if you have to leave, that is just an unepected curve, not a failure. Navigate it as best you can, and look for the new opertunities on that new, unexpected road.

Thank you sooo much for having the guts to share your feeling on this topic. We can all hear your heart that your goal is to care for those patients as best as possible. Frankly, having been a patient of a new grad, I would in many ways prefer a newer grad versus an RN who assumes or who has lost that fire in the belly... I am sure you will be great - because from the amount of thought you put into it, you already are... and you just need to believe in yourself to know that you are that Nurse that you want to be... Keep your head up!! :-)

I'm saving, printing, and hanging this article on my fridge. I'm about to turn 35, and I've applied to an RN program. If all goes well, I will be graduating when I'm 38, and I, too, am an anxiety-ridden worrier. I want so badly to be good at this job that I haven't even started school, yet I have anxious moments doubting my ability to actually one day do it. It has crossed my mind that I'll stress myself out once I'm finally out there doing it. I need to remember others feel- or have felt - the way I probably will. Thank you for your honesty.

I just started orienting on the floor last week and I am totally nervous for when I go out on my own, gulp. It seems so foreign to care for 5-6 patients on a normal day. My preceptor makes it seem so easy. My problem is I am not Type A personality, I am very adaptable to chaos and interruptions which is a good thing for the floor I am on, but at the same I forget simple things. I run back and forth too much and probably have the worst time management of any nurse haha. We'll see what happens when I get off on my own!

What you are feeling is normal! I feel that way sometimes! Even experienced nurses feel that way!

I've been in your shoes too. The crying and worrying seems to me in part due to physical and emotional exhaustion. The reality on busy acute floors is often 12 hours without breaks or meals. An absolutely insane pace, in other words. I call it brutal and completely unnecessary. The only reason for it is not providing enough staff to ensure a humane workplace. Don't get me wrong. This is where I also choose to do my work and gain the skills to make me a well-rounded nurse. But I believe the research bears me out, that the pace and lack of time to eat, rest, and re-charge is a disservice to nurses and patients alike. Experienced nurses are better able to handle this I suppose, because they've adjusted and can organize and prioritize better. My heart goes out to all the new nurses struggling to "make it" their first year.

Specializes in Public Health Nurse.

Hope, hang in there. I hear it gets easier as you go along.

I hope you have a great team in your floor. I feel that no matter where you work, if you have a good team that supports each other, the job is easier.

Congratulations on your job Hope, and now go and be the best nurse you can be :yes:

Specializes in Emergency, Case Management.

I have been searching the internet to find out if the emotions I am feeling as a new nurse are normal. This website (specifically this article) is amazing. It is so wonderful to know that you are not alone! I started working at a pretty hectic ER one month ago and some days are awesome and some days I cry myself to sleep at night just to wake up with an enormous level of anxiety as I drive to work the next day. I need to look at this experience as a learning opportunity. Take everything in like a sponge and hopefully get through this first year as best as I can!

Specializes in Public Health Nurse.

@ blueyedgaze, I wish I can tell you that I know what you mean, but I do not. However, as normal as it may be for this process to occur, try to find a day where you can disconnect completely and recharge. I think your idea of approaching this as a learning experience is great, but then again, do not we not all approch it from that perspective?

Sending you a big hug and as I told Hope, hang in there, the days will turn into weeks, then months, then years, and you will have transitioned from novice to expert :yes:

I feel the exact same way. Had my first "super crazy no time to breathe" shift last night. Got home and although exhausted, I lied awake for hours thinking "did I do everything right?" "Should I have done more?" "What did I miss?" etc.

Great article! Many new grads like myself can absolutely relate to what you have to say. I'm going on 4 months on my own without my preceptor. I can absolutely relate with the lack of confidence, the constant self doubt and worry, the overwhelming stress of keeping up with assessing your pts, passing their meds, doing procedures, dealing with their needs, and micromanaging everything else, and the paranoia of whether or not you missed anything. I work in the cardiac telemetry unit, and I'm always nervous because these patients are extremely sick and it can be very stressful at times.

But the good news is you passed nursing school! You passed the boards! Nursing isn't easy. No one expects you to know everything once you get out of school. In all honesty, it's ok to feel this way. I, personally, would be worried if you didn't. I always get frustrated when my time management suffers, or why I don't know certain things. The answer is simple. These experienced nurses have been doing it for a long time. They developed a routine. They honed their skills. They have a wealth of experience. It really does take 1-2 years to become comfortable.

So, just remember you're just starting out. Take time to learn and gain experience. Be patient with yourself! Focus on the positive. While it's human nature to dwell on the negative, if you focus on the positive, it will become your reality and you can progress forward. Find out who your resources are so you know who you can turn too. You can only do so much, you're just one person. When things become too overwhelming and you're in the verge of tears.......take a step back....breath......and get back into the groove of things. Most importantly, make sure you take time for yourself! Nursing is very rewarding, but it is also very stressful. You can't take care of a person well if you don't take care of yourself first! :up:

Great post to read. Honestly is helping me to relax and get to sleep before working in the a.m. I too am a new graduate nurse, just started a little over a month ago in an emergency department. It is helpful to know that others put there are feeling the same way that I do. I come home every night with such bad anxiety that I did something.wrong or forgot something in report. I totally understand how you are feeling. It's not an easy career! Hopefully the anxiety will dissipate with time for the both of us. We can do it!