15 Things I Wish I Knew as a New Grad Nurse

One year ago, I began as a new grad nurse, every fiber of my being laden with trepidation and excitement. I pulled up my compression socks, laced up my promisingly supportive Brooke’s ghost shoes and stepped foot into the hardest year of my life. I didn’t think anything could be more challenging than nursing school, and I was in for a rude awakening. Everyone says the first year of nursing is the most challenging, but it’s hard to grasp until you are in the throws of the anxiety, incompetence, and fear that plague your every day. There are a few things I wish I had known or someone had told me before I began this year, and maybe, just maybe, this can help some new grad nurse out there on this emotional, wild, and spectacular rollercoaster.

  1. You will make mistakes. For some reason, I didn’t realize that as a new grad nurse, you make mistakes. No one ever said point-blank, buckle up, you’re gonna screw up…. a lot. Maybe people don’t talk about it because we have people’s lives in our hands, and we should strive for perfection. This is true, but I think it would have saved me much of the intense self- badgering if I realized mistakes were inevitable. Don’t get me wrong– always triple check your meds, doctors orders, operate in professionalism, always do your absolute best….. but every little mistake from having an overdue med due to mismanaged time (IT WILL HAPPEN) to forgetting to unclamp your piggyback antibiotic (everyone has done it) to not charting something correctly is an opportunity. Never try to cover it up, make sure your patient is safe first and foremost, and then… learn. Trust me.. you won’t make that mistake again. Do not beat yourself up. Repeat after me… Mistakes= Lessons, Lessons= Growth. You need the mistakes to grow, and each mistake is molding you into a strong, robust, competent nurse. The mistakes will become fewer and farther between, but they never will entirely cease. Neither will the lessons, and neither will the growth.
  2. You will experience a new level of anxiety, but it will get better. Every single day I stepped onto the floor, the anxiety overwhelmed me in a way I have never experienced before; it plagued the crevices of my mind and soul. I felt like I was operating in flight and fight at work AND at home. I couldn’t separate the two, and would often wake up in hot sweats- “Did I return that med?! Did I chart that?! Oh shoot, I forgot to get that patient ice chips!”… I had literal breaks with reality. One time I woke in the middle of the night panicked because I thought I had forgotten to give my husband insulin (he does not have diabetes). But somewhere along the line, I was able to turn the “work” brain off. It took a long time, but now a year later even though I still think about my shifts, it doesn’t carry the same anxiety provoking reflection it did at the beginning. I still shed plenty of tears for my patients on the way home or the next day after a hard stretch of days, but it’s out of mourning for and with them… not from anxiety.
  3. Those impossible skills…. become possible. One of the most frustrating parts of being is a new grad is the lack of agility and the constipated pace of your skills. Tasks that are super “easy” to most seasoned nurses still scare the code brown out of us. Even priming IV tubing seemed like a formidable obstacle when I began (air- in-line alerts sent me straight into cardiac arrest). By the end of the year you will be taking out central lines, hanging blood, straight cathing, and working with PEGs/trachs like it ain’t no thang. Hands on skills were my weakness, I didn’t think I’d ever get the hang of it. But somewhere along the way, I did. And trust me, if I can do it, you can do it.
  4. 12 hour shifts are long, but nursing is a 24-7 job. One thing that I didn’t quite get when I began is nursing is a 24-7 job. Yes, in those 12 hours that belong to you, the weight of people’s lives are in your hands. But always remember— it’s a 24-7 job. Do your best not to pass on any tasks, make sure you give all your shift meds, but if you don’t get around to changing the now expired IV tubing because your patient was physiologically unhinged and you were keeping them from grave, it’s ok. I used to think I literally would get fired if every single little protocol ridden task was not completed. Some days, all you can do it keep someone alive. It’s a 24-7 job. Just remember that.
  5. Yes, you can do another day. Countless times I thought to myself, I don’t know how I can do another day of this. Sometimes we have such a bad first shift in a stretch of three, and we don’t know how we can physically or emotionally handle the next two. But you do. You just do. After enough times of thinking this, and enough times of doing that “next” shift, you start to know that you can, in fact, do another day.
  6. Listen to your patients! Sometimes symptoms are not textbook clear. If a patient says they feel “off”, listen to them, closely. What is off? When did it start? Listen to their concerns, even if they seem unwarranted, because often times they are not. There are clues in conversation, history, and in chats with family that may not show up in vital signs.
  7. Patients listen to you, closely. Patients will ask you so. many. questions. Sure, you may know some, but there are plenty you will have no clue. Do not be afraid to say, “I don’t know, but let me find out!” or direct the question to the proper team. Something I have discovered is when you have those scrubs on, patients take you at your word. Even if you put a disclaimer- such as I’m not 100% sure- or, make sure that’s ok with your primary doctor, or “I think _____ but double check with ___”….. they will only hear the answer part of your statement. Avoid saying those disclaimer statements, because as soon as it is out of your mouth, they will hear my nurse said ____ and take it as truth. It’s better to utilize your resources (call pharmacy, ask your charge, ask the MD) and give them the most informed answer possible.
  8. Listen to your gut. “What gut?” you may be thinking as you have only been a nurse for about a month. Ok, your gut will develop as time goes on (and I’m not just talking from break room potlucks and donuts). If you have that “bad” feeling… investigate why. There are so many times I wish I had just listened to my gut a bit more. Just last week I had a patient who I had a off feeling about. Nothing had changed in their baseline neuro exam or technically by physiological assessment. But I knew something wasn’t quite right. I told the MD, but he had no real basis to conduct any additional tests either. I told the next shift nurse about this feeling too… and the next day when I returned this man was in the ICU. Trust. your. gut.
  9. Nursing Assistants are vitally important. Y’all. I don’t think I understood just how important nursing assistants are before starting this gig. They are massively crucial to our success and the patients’ success. The nursing assistants on my floor are brilliant, many have been working for years and single-handedly keep me afloat some days. I learned (and continue to learn) a tremendous amount from them. Do not be afraid to ask them for their tips/tricks in patient care.
  10. “Thank you” goes a long way. This may seem elementary, but as a nurse, you begin to understand the weight and gravity of a thank you. Give thank-yous out like candy. They are free to give and priceless to receive. Thank your housekeeping staff, your charge nurse, your transporter, your nursing assistants, the previous nurse who tried her best to get loose ends tied up for you, doctor’s, PT/OT who helped your patient walk for the first time since surgery. We are a family in healthcare, and it’s so important to remind them they are all appreciated.
  11. Make recommendations, and happily accept constructive criticism in return. ISBAR- the “R” (for recommendation in communication) is especially hard for a new nurse, but do it anyways. You will get some MDs who will make you feel as if your idea is the worst possible idea they have ever heard. You will also have others who will kindly suggest an alternative. And EVEN some who will accept your recommendation. Regardless of the response, ask them to explain the reason behind the intervention/order/medication, and then thank them for taking the time to explain. It will go a long way in developing rapport among you and the provider.
  12. Go the extra mile. Cue the eye rolls from my nurses in the back. I get it, we already are given an impossible to-do list every day. There is no way to go the “extra mile”. Or is there? When I first began, I barely saw my patient. I only saw the to-do list. I barely had time to be with them, because I was just trying to get it all done. Yes, this is the way of nursing now it seems, but sometimes, just taking the tiny extra seconds to hold their hand and say, “How are you” at the beginning of a shift or offering an extra pillow can make all the difference. This one takes time to conquer, but you’ll get there. I am still learning how to do this, and it takes reminding myself daily to just look the patient in the eye and not just to examine their pupils.
  13. ASK ALL THE QUESTIONS. Not sure how I didn’t have this listed as number one… but ask every question. Do not assume ANYTHING. You will feel like you are grating the nerves of some other nurses, but you will learn who your best resources are. Remember, a little annoyance is nothing in comparison to someone’s life. Even the slightest bit of doubt, check it out!
  14. ‘You time’ is necessary time! “On the clock” for us is a fight of life vs. death. When you are off the clock embrace your life- do what you need to do to take care of you. Go for a walk outdoors, exercise, do yoga, pray, write a letter to your friend who lives far away, get a massage (get multiple massages), pedicures, go out for a nice dinner, nourish your body with healthy foods (and nourish your soul with dessert), travel, or do nothing at all. Find what helps you relax and disconnect. I didn’t want to be social at all for a good six months and found myself in a hole of isolation and depression. I didn’t think I had the energy to do anything. But once I started making plans, planning trips, etc. things started turning around quite a bit. Find what works for you!
  15. It’s worth it. Oh my fellow new grad, you don’t know if you will survive, but you will. I know it’s hard to believe, but things will get better. People would say that, and I just didn’t believe them. Have faith. You are stronger than you think. This year, yes it is hard, it’s probably the hardest thing you have ever done, but it’s worth it. When you see your competence start blooming, so will your confidence. When a patient tells you that they will never forget you, it’s the most rewarding feeling in the world. Through this whole process you are impacting countless lives and countless lives will impact yours. Soon you will have forever-in-your-heart moments, unforgettable connections to patients, and “good” days under your belt, or stethoscope rather. Write them down and remember them. Because at the end of the long twelve hour shift day, there is no amount of fear, anxiety, or bad days that can overshadow the honor it is to be a nurse.

You’ve got this!

Ohh, and never use the “Q” word. Never, ever, ever use the “Q” word.

51 thoughts on “15 Things I Wish I Knew as a New Grad Nurse

  1. Even though I’m an RD & not an RN, I almost wanted to start crying. I feel like this relates to a lot of what I felt in my first two jobs in my career. Granted, they’ve never been this level of intensity or as complex, when I was working in nursing homes, I feared making mistakes. I went thru a rough patch that put my job in jeopardy. Lets just say my attitude needed to be put into its place. 😉 But nothing really prepared me for my current job in renal. I started to really feel my anxiety soar, fears about disease took form, & I finally sought therapy. Every day presents new lessons, & I certainly have my share of good/great/horrible days. My patience can be worn thin, but then I’m able to refocus & return the next day. It’s rewarding to serve as a dietetic intern preceptor so that I can help play a small rle in preparing new, up-&-coming RD’s. Thank you soo much for sharing this reflection! I’m in absolute awe over your strength & maturity. And that you are a kickass RN – the medical procedures you mention are so complicated, but you have saved countless lives already!! <3

    1. Kori, wow, thank you so much for your response & sharing your heart. There is nothing that can bring out the bad in anyone than STRESS! There are times where I regret the way I respond in a super stressful situation at work or the way I show my emotions in front of patients because of stress. But remember, it’s ONLY human, and this is how we learn, and oh myyyyy are we ever learning (and evolving). I resonate with every single thing you said- what we all do is hard work. Even though it’s slightly different, the waves/obstacles/ and emotions of learning a new job in healthcare are similar. Thank you for bringing this to my attention! And thank you for all YOU do… we can treat dialysis patients all day, but if they don’t understand proper nutrition it doesn’t matter. Sending massive hugs and allll my love! Thankful for you, Kori <3

  2. For the past two weeks I’ve been immersed in the hospital world as I visit my 82 year old father who has found himself recovering from two surgeries and is currently under the care of two teams (vascular and cardiology)…I used to work as a nursing aide and medical office assistant…your words ring true, I’m grateful for the care my Dad is receiving…his outcome is uncertain but we’re hoping for the best…with nursing staff like your dear self on his floor, my Dad has been given a fighting chance!

    1. Kimberlee, I am SO sorry you and your family are going through this <3 Thank you for sharing this with me. Thank you for your kind kind words. We actually are considered the vascular floor in the hospital as well, so your Dad holds a dear place in my heart (That and he is YOUR father!). I am praying for him, I am writing him right now on my prayer list. I pray the doctors and nurses are given the utmost wisdom! Sending you all my love. <3 Thank you for trusting me with this piece of your life.

      1. Thank you so much, Mackenzie…this just warms my heart and to have him placed in your prayers is a beautiful gift! I spoke with him by phone this morning and he’s on his way to a transitional care unit at a different hospital allowing him more days to recover…we are unsure how this piece will fit in going forward but are hopeful that things will fall into place as they are meant to be…your kind thoughts mean so much to all of us during this time, I’m forever grateful!

      2. Aw I hope that this place is the perfect healing environment for him! And of course, I will continue to be praying. Sending blessings and love to you this weekend. ❤️

  3. You sound like you’ve grown in leaps and bounds this past year Mack, truly, I have so much admiration for you and for all nurses. I’ll never forget the care that was given to mum when she was in hospital. I often commented to the nurses how grateful I was for what they were doing, it must be an extraordinary challenging job. This is a wonderful post Mack, so many lessons pertaining not just to nursing but life in general. Rock on girl, you’re amazing. xo 💕

    1. Miriam, thank you so much for sharing these sweet words with me <3 Reading this just made my morning. I am thankful your mom was given such wonderful care, thank you for taking the time to share with me <3

  4. As a patient, the nurses really make the stay so much better. The recent visit I had, one nurse had to take three tries to get the IV in, but she was still a stellar nurse. When they switched me from a delivery bed to an ante bed, I was so grateful, and apparently that made the nurse feel on top of the world to bring that comfort to me. You guys are our advocates for care and comfort. I would ask so many questions, like opinions about what to bring with me to my c section. And sometimes I would ask for updates from the fetal monitoring. I could tell they were so careful to disclaimer everything they said that at one point I told one of them, I’m not holding you to your opinion. I realize it could all change in an hour. And they were so busy and still gave me the time and attention I needed. I’m ever so grateful. What would you suggest as gifts for nurses for after this baby comes?

    1. Wow, thank you for sharing this with me, Katy! And you sound like you were an awesome patient… many patients would rule that nurse as a bad nurse just because it took 3x for the IV, so that’s sooo good to hear you call her a stellar nurse still 🙂 I’m very very thankful you had a great experience (for what it can be!). Awww, oh my gosh, you are so sweet! I would say anything that can be shared with the unit!!! Food is always a safe bet 😉 On those 12 hour shifts rarely anything brings more joy than surprise goodies in the break room! Also, just a note of thanks… if you have a superb nurse let the manager know. Those are the types of things that go super far! <3

  5. This was a fun read and I’m not even a nurse! A lot of this can relate to other jobs too! When I saw the first was that you’ll make mistakes I went “yes girl!” in my head lol. I make mistakes in my job and they are such helpful learning tools. Sounds like you have come a long way in the first year as a nurse Mackenzie!

    1. Thank you for even taking the time to read, Maureen!!! Aww, it’s nice to know this relates to others too that aren’t even nurses <3 Those stages of growth are all so very similar, huh?! Thank you for all your encouragement along the way!

  6. Love your list!
    I learned the hard way, patients often don’t tell you everything until you ask twice how they are doing.

      1. I’m a Perioperative nurse. ( sorry, I think I missed the question when I originally saw your comment!)

  7. Girl reading this made my heart so happy. The “baby nurse” is all grown up and able to fly! Seriously! I am SO proud of all you have learned and accomplished. You haven’t just learned how to be a nurse in your field, you have tackled so many important life lessons and you have grown by leaps and bounds and I could not admire you more! <3

    1. Awww thank you, beautiful!!!! <3 You have been there from the beginning (Before the beginning, really!). So thankful for all your love, support, and true kindness through this crazy journey. Words cannot express my gratitude! XO

      1. Aweee Mack this comment is the sweetest! YOU are the sweetest and strongest woman I know and it has been incredible to watch your journey. I am so incredibly proud and grateful to be a part of it! <3

  8. So much of this resonates with me. When I started my first post-college fill-time job at the age of 23, I was SO.OVERWHELMED. I left work feeling so incompetent, scared to the core, and riddled with anxiety. I feared mistakes, being annoying with my questions, and not succeeding in my daily & monthly goals. I graduated with a degree in psychology but didn’t have a clue what I wanted to do. I was fortunate to obtain a job with a great company as a Financial Counselor where I had to contact an entire account base of customers that I was solely responsible for that were past due on their mortgage, & I had to determine a solution. It was so daunting to say the least to be on the phone, talking with strangers, having to think at lightening speed to make sure I covered everything and ran the numbers correctly while working in a cubicle such that everyone could hear me. Not to mention, some people in this world are just SO unpleasant (read: hateful to the core) & will let you have it causing you to just get stiff with anger because you are just doing your job. I am happy to say that I survived several years in that position and now am in the same department but processing different tasks. Some days for seemingly no reason I’ll feel some anxiety well up a tad, but I can squash it pretty quickly now.

    Thanks for sharing such a refreshing post that is relatable to so many!

    1. Kaci, wow thank you thank you for always sharing these parts of your life with me too. Maybe this is a process not just in nursing, but entering the real adult work world in general! It’s good to hear that things are better and even when they are overwhelming, you’ve learned to cope. That is what I think is so instrumental through these challenges !!!! It makes me so happy that you resonate with this as well. I admire your strength, Kaci! Have the best weekend 🙂

  9. This is so beautiful, Mackenzie! I love, love, love your passion for your career! I can tell God has you in the right place! I sent this to my sister (she’s in nursing school), and I think she will LOVE it 🙂

    1. Oh my goodness, Allie!!! Thank you thank you for sharing with your sister. That means tons. I hope it helps her and gives her some peace!

  10. I would leave a longer comment, but I really don’t have much time on my hands. But I just have to ask…. What is the Q word? 😛

    1. Hehe, Cyr! You crack me up!!!! Uh oh, are you going to make me say it?!?! It’s Q U I E *. (I won’t type the whole word, but I think you can get the gist ;)). It’s the ultimate jinx. If you say it, then all chaos is let loose on the unit inevitably. I have seen it and done it. I learned my lesson quickly with that one!

      1. My oh my!! I know! (my best guess was “quit” before I read your reply) The Q word is indeed a total jinxer!

        When I used to dispatch ambulances, someone used it, one “Q” afternoon. I looked at the girl right away, telling her that we NEVER mentionned when it was “Q”!!! And she laughed! Well, it must have pissed off the Jinx Gods because not 5 minutes later, we got a (thousand) call for a major chlorine leak in a big plant! I had to supervise the transportation of over 35 people that afternoon (by far the most serious “event” I had to take care of)

        Believe me, I’ll make you say Beetlejuice 3 times before I trick you into saying the Q word 😛 LOL

      2. Ahhhh noooo! That’s an INSANE story!!! Holy guacamole, serious stuff there!! Seriously, I am not one for the superstition, but I really do think there is something to that! ahhh phew, I’ll take beetlejuice anyday! LOL

      3. Mouahahahahaa I agree! I don’t consider myself superstitious either… But I am starting to believe that that Murphy guy exists, and has a tiny mic on me. LOL

      4. LOL! Oh my gosh, Cyr, I am going to steal that from you. Hahahah. Literally, that should be the nursing (or any medical professional’s) tagline. Goodness, I’m cracking up! Lol!!!

  11. I love love this post. Reading about your nursing adventures is my favourite thing; it’s brilliant to see how much you’ve learnt/what you’ve realised.

    I particularly love your point about saying “thank you.” They’re a lovely couple of words! <3

  12. Aww Mack! I can’t believe it’s been a year now on your nursing career! Congrats!! And thank you for sharing this– I’m sure it’s helped so many people including myself with how relatable it is and just to show that you’re really never alone on this nursing journey/ adulthood career. There are so many times where I go home still thinking of my patient and come back the next day and still asking about them and sometimes I feel like, “am I too invested and am I the only one who cares because none of my coworkers seem to bring it home with them and care how I do” lol but it’s nice to know that I’m not the only one feeling this way!! Thank you for sharing with us all your vulnerabilities and the things you’ve learned and continue to learn! Hope all is well!!!

    1. JESCI!!!!!! Hey girl!! Oh what a treat to have this sweet comment from you. Isn’t it crazy how this year has flown for us both?! You are not at all alone in that feeling! I think after more and more experience the difference is learning to compartmentalize. It doesn’t mean you care less, you just learn how to not let it seep into your personal time as much. I think about you all the time with our RTs. I have worked with them a ton lately and have had to do more trach care than usual (That’s always the scariest task for me!). Thank you for sharing that you have felt many of these things as well. Hope you are so well, girlfriend!

      1. Aww, same girl! I think of you often and I’m so proud of you! It took me a while to get used to trach care.. I always freaked out taking out the inner cannula and putting it back in without feeling like I’m hurting them! But as time went on, I got the hang of it! Looking forward to catching up on your posts! Congrats again on getting accepted to Vanderbilt’s MSN-FNP program! So blessed, God is good!

  13. I wish I’d seen your post years ago when I was a new grad. I actually teared up reading your words, it truly resonates. Oh the fear and self doubt! Thank you for the reminder of what it was like to be that new nurse in the first year after school. I am going to make a point of being extra supportive of our new grads.

    1. Oh my goodness, Karen! You just made my whole day. Thank you for reading and for affirming these thoughts and feelings. <3 Thank you for all you do too! Happy Nurses Week! XO

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