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."

I literally took the words right out of my mouth! I am the same EXACT WAY. Step down unit, 5 patients, always running around. I too wonder if I was alone in not knowing what the hell I'm doing most of the time. Every other GN seems to be getting better, and I feel like I'm the only one who's scared and intimidated. I worked night shifts, one time (my 5th week into floor orientation with 3 patients) I went home, fell asleep, and wake up 2 hours later crying for like an hour LOL. I'm so glad I'm not alone in this. Thank you for sharing, and thank you veteran nurses for your kind support!

Specializes in Trauma- Med/Surg.

I feel exactly the same way. I work nights on a med/surg trauma unit at a very busy teaching hospital and I am about a month into my orientation. The first three weeks I oriented on days, then had a week of nights, then have to cross train on another unit on days then once again go back to nights. I can't even keep track of my own schedule! When I get off my shift sometimes I don't even know how I feel. Exhausted, happy I made it through the night, nervous I missed something, depressed, tearful for no reason and anxious because after the tossing and turning throughout the day and lack of sleep I have to pick my chin up and do it all again. Everyone on my unit for the most part are really supportive and helpful, but it is so much stress as a new grad. I feel like all I do is chase my tail all day. Everyone keeps saying if you can make it on this floor you can make it anywhere and it will get easier. Usually I am very organized and great with time management, but one set back at the start of a shift seems to spiral out of control for the rest of the shift. I do like nursing and still feel like I made the right choice, but my goodness I can't wait to at least feel like I am half way comfortable in what I am doing!

I can not thank you enough for this article. I work on a very busy Surgical Unit, this is my 2nd week out of orientation. During my orientation I absolutely loved it, my preceptor kept telling me how well I am doing, I thought to myself ok this isn't so bad. Oh man was I wrong! I constantly worry that I will miss something. I am very fortunate to have an amazing team of nurses to work with, they are incredible asset and don't mind me asking questions. But the true worries begin when I get home, I get so anxious and go over every little thing, I get to the point I can't eat, I am starting to have trouble sleeping. Last night I woke up at 1.30am freaking out that I forgot to take tele monitor off my patient when I send him home. I went over my had 20 million times and finally realized he didn't have tele monitor on him in the first place. I had 2 days off and I am going back tomorrow for 3 day shift and I am terrified to no end. I pray it will get easier, I have always wanted to be a nurse ever since I can remember, now at almost 40years old I fulfilled my dream. I love taking care of my patients and love everything about nursing, I just hope I can get more confident and it will get easier with time.