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Yes, even preceptors who have helped me learn to see the big picture are not without their quirks and rituals. Perhaps it is also about control.

Maybe my view of things is warped because I never worked as an NA. But lately the aides have been driving me nuts from 0400 onward (nocs) with the lengths they'll go to to ensure the trash cans are completely empty by last rounds. To be clear: I don't fault them for wanting to hand off a spotless room. I am annoyed at whatever ridiculous communication tool they fill out with the oncoming shift that dings them for waste as negligible as a couple of gloves and used flushes in an otherwise empty bin. One of the aides hauls their own bag from room to room, removing nurses' and patients' careless last-hour trash from the bedside cans. At the long-term care facility where I work per diem, I was once chastised by another RN for "using the NA's trash" when I threw away an empty 250 ml carton of feeding in the room. That's when I found out this nurse only disposes of supplies into the bin attached to her med cart. Interactions like these make me feel bad, like coworkers think I'm being inconsiderate on purpose. I do change the bag if I have time. I try not to "stuff down" an overfull bin. It just doesn't make sense to me to carry a separate cup or bag in for "my" trash, then leave the room with it to find an appropriate receptacle that won't peeve the aides.

Wound nurses are awesome! Floor staff can't stage ulcers at my facility. We can only describe what we see and request a WOC consult. Luckily the advice to describe drainage that looks suspicious for infection as "purulent" instead of the adjective version of "pus" has stayed with me.

The fear you have, in the form of mild stress, will help keep your patients and license safe. Just because you are now the primary nurse for a group doesn't mean you aren't allowed to ask questions anymore. No one should practice on an island out of fear of being shamed or belittled. Peers want you to demonstrate an ability to think critically: What is your concern? What assessment data are you working with? What interventions have you tried or plan to try, and why? Think 'SBAR.' Nurses are constantly reading people. They form judgments quickly. This may seem unfair, but it is more of an adaptive tool to understand each teammate's strengths and weaknesses. If you have a habit of not speaking up, coworkers assume you either: 1) know nothing, or 2) know everything ("The new grad is fine. S/he doesn't ask for help. Well, they worked here as a student, so that's probably why.") Both conclusions are wrong--even harmful. I graduated with nearly debilitating impostor syndrome and anxiety, and was also described as "quiet" (re: shy) throughout school. To top it off, I admittedly entered the profession with relatively little life experience. Some preceptors were harsh in their criticism, taking the "tough love" route. Other instructors were more compassionate, but still firm. And then there were staff nurses with decades of experience who suggested I simply wasn't cut out for this field. As someone with a tendency to internalize the bad and not believe (or recognize) the good, receiving these comments almost made me want to quit. But I am grateful to everyone who ever approached me with honest feedback. On the theory side, From Novice to Expert by Patricia Benner gives the beginner nurse an idea of what clinical growth looks like. Refer to this framework from time to time. Ask yourself what stage you're at. Think of examples from specific shifts. Regarding personality, I agree most nurses are Type A. It's because our work--and society in general--favors assertiveness, often conflating confidence with competence. This is understandable when someone's life is literally in your hands. One nurse educator had my new grad cohort assess our "mind styles" using the Gregorc model. I realized my results were different based on whether I answered as my "true self" versus the way I am at work. So even if, like me, you are naturally introverted, you can't seem unsure of yourself at the bedside. You must learn to communicate, show what you know and, if necessary, fake it till you make it. The truth is that you are expected to be more task-oriented in the beginning. Lists are your friend. Ask questions if you feel unsure. Copy the best workers. Return-demonstrate skills with supervision. Review the unfamiliar. Try to place your patient's vulnerability above your own self-consciousness. And don't forget to be kind to yourself. Don't neglect your health. Breathe. You deserve to be there. You have the education, the foundation. It is up to you to get the best training you can. Great nurses never stop learning.