There is no shame in being a struggling new grad nurse. Being a new nurse is very overwhelming. Starting a new job is tough already, let alone an entirely new role with much more responsibility that ultimately puts you in charge of the life and safety of other people. But, no pressure, right?
Getting through nursing school is an exhausting journey, and many of us anticipate feeling prepared starting out with that first job right out of school. However, once we get to there, we feel a sinking reality check: We’re not nearly as prepared as we thought we would be.
Countless questions … feelings of inadequacy … a million new processes to learn … dozens of people to meet … and all of a sudden there is a vulnerable patient right in front of you who expects you to know it all.
While it may seem like an impossible place to grow from, I can tell you that you can, and you will. But, rather than focus on being the best at starting IVs, BFFs with the doctors, or knowing every fact about every med, we need to take a different approach…
4 Tips to Curb Feelings of Overwhelm as a New Nurse
Growing from a green nursing student to a confident and competent autonomous nurse takes time, patience, and grace. It’s a slow-burn journey, not some theoretical light switch that gets flipped from off to on once you legally can write RN behind your name.
I walked through this over a decade ago, and the process of becoming competent entailed many unexpected steps that I hope to impart to you and make your journey smoother (and hopefully a lot less hard on yourself than I was!) I was not prepared for the intense feelings of overwhelm and anxiety that accompanied being a new nurse.
Therefore, let’s discuss a few practical steps you can take that will help you decrease these often overwhelming feelings of incompetence so that you can truly focus on what’s most important: How to become a better nurse with each shift.
#1 – Recalibrate Your Expectations From Nursing School
I had this mentality all throughout nursing school that if I just buckled down, did what they told me, checked off all the right boxes and passed all the tests that I would be ready and prepared to excel as a new graduate nurse. I assumed that the entirety of nursing school was preparing me to enter the workforce fully trained, and that orientation at my first job would essentially consist of being shown around the unit and I’d be off on my merry way to care for my patients by myself.
In clinical, I observed all of these nurses who appeared to be flying solo and working well by themselves with their patients. I assumed that if I asked people for help, that meant I was inadequate and not excelling. This was worst-case scenario in my mind. I needed to impress. I needed to wow everyone. I needed the grumpy nurse to love me. I needed to say the perfect thing to the patient consumed in grief. I needed to be the best. All-encompassing feelings of inadequacy wasn’t supposed to be part of the picture.
When I started that first job, I feel like such an impostor. I felt like I was flying under the radar, just praying that no one would ask me a question I didn’t know the answer to.
About 3-4 weeks into my residency program, I realized I wasn’t alone. Literally everyone felt like this.
After talking with many nursing administrators over the years, I can confidently tell you that learned that nursing leadership does not expect that of their new grads either.
Therefore, I really want to encourage you to examine what you genuinely expect from yourself.
What does your brain assign as a successful performance in this job? Write it down. (Seriously, writing things down externalizes it and gets you out of your own head for a moment!)
If I were to do this exercise back in 2010 when I graduated, this is what my list would have looked like: I don’t want to make ANY mistakes, I want to be the best nurse on the unit, I want to be the favorite of every physician, I want everyone to love me, I want to know all of the meds, I want to get done with my tasks early every shift.
Next, I want you to listen to this podcast episode where I sit down with two nursing leaders as they pull back the veil and give you insider info on their genuine expectations. Then, I want you to ask yourself if what you expect from yourself is realistic.
While it’s admirable to have lofty goals, if they’re not grounded in reality you’re essentially just setting yourself up to fail constantly. It will be impossible to win, and this will undermine your attempts to curb feelings of overwhelm. There is no badge of honor here for whomever is meanest to themselves. This is a terrible place to be mentally as you learn a complex job.
Sometimes, we need to get out of our own way.
One step isn’t going to cure feelings of inadequacy, but by recalibrating our expectations of ourselves, we certainly can make it a much more hospitable environment for your professional growth.
#2 – When Feelings of Inadequacy Bubble Up, Push Back On Them
In my early twenties, I heard a psychologist say something that really hit me hard: “Just because you feel something doesn’t mean it’s true.”
Wait… what? I thought that feeling something strongly was evidence of truth?! Oh, how wrong I was.
Feelings can help provide important information, but feelings themselves are not facts. This can be hard to reconcile when you’re caught deep in your feelings, but it’s an important truth.
Wise decision making considers feelings, but is not solely guided by them.
Therefore, if you feel like a terrible nurse, it doesn’t mean you are. Try to change that from “I am a terrible nurse,” to “Right now, in this moment, I feel like a terrible nurse.”
With all of the pressure and complex emotions that come up during this really challenging journey, it can be tough to make sense of things. So, the first step is to identify when you feel like this. Simply saying to yourself, “I feel really inadequate right now,” is powerful. Giving words to feelings and experiences helps externalize them and therefore get control over them.
Then, remind yourself that you’re on a tough journey and doing the best that you can.
Right now, I feel really inadequate. Every new nurse feels like this. I am not alone. I’m choosing to focus on getting better every shift, not being perfect. I can do this.
Remind yourself of this repeatedly.
- When wake up in the morning (or evening, if you’re a night shifter!)
- When you’re getting report and start to think, “I can’t do this”
- When you’re going in to talk to your grumpy patient
- When you’re about to page the notoriously rude PA
- When you miss an important order
- When you’re balancing 7 tasks at once
The more you re-frame this as it comes up, the easier it is for your brain to go to a healthier place during these moments. (This is called neuroplasticity.)
With the first tip, I mentioned getting out of our own way. This takes it a step further by helping you move forward.
#3 – Focus on the Baby Steps in Front of You
It never fails. You clock in, and somehow you’re already 2 hours behind. A patient is already late for surgery. One has a med due in 90 seconds. Someone has to pee, and another person’s ride is here and wants to be discharged NOW.
Phew, what a way to start a shift!
It can be easy to come against the feelings of overwhelm and shut down. We doubt how we can get through the next med pass, let alone the entire shift!
My advice: Zero-in on the small steps in front of you
Let’s not think about clocking out 2 hours late right now. Let’s focus on delegating getting that patient to the bathroom and finding out what the hold up is in the OR. Next, we’ll graciously remind the patient who wants to be discharged that the physician has to enter discharge orders and impress upon him or her that you will prioritize getting them out the door the moment they come through. Finally, we know that we’ve got some buffer time with meds so we’re not going to worry about the one that’s due right now and we will get to that once the other stuff is addressed.
When you can re-focus on the small steps in front of you, it makes a large challenge seem much more doable.
#4 – Identify YOUR Priorities
Many people will act like absolutely everything is a priority right this very second (from therapy, to management, to the doctor, to the PA, to radiology tech, to the family member..), but you as the nurse must look at your task list and prioritize everyone’s priorities.
Everything is a priority to everyone, I need to decide what is a priority for me right now. I am the nurse, the common denominator. I see the big picture. What needs to be done right now?
I feel like a lot of a shift is reassuring people and calming them down because things don’t happen as quickly as they want them to. It is 100% okay to make people wait, when appropriate. You’re the nurse, your the one whose time is absolutely precious. Now, I’m not saying other people’s time is not, but you are the gatekeeper for your entire patient load and can only do one thing at a time for each of them.
Remember: You get to dictate the order in which you will complete tasks.
At the beginning of my career, I thought I had to do everything one everyone else’s timetable. Every time someone came to me with something they needed or wanted, I thought I had to drop everything and immediately address it. And these requests are so frequent that your entire shift could just go from someone else’s need to someone else’s need and you’d never sit down.
But these people don’t know what you have to document, tasks you’re required to complete, and all of the assessments and monitoring you’re responsible for. They see their need only. They don’t make a request from you with full knowledge of what you’re facing.
This isn’t like Only you know all the things you need to get done for your entire patient load in the next 1, 2, 4, and 12 hours. You can make the call of what is now the priority (unless there is a legit drop everything emergency).
Sample talking points
- I hear that you need _______ right now and I will address that as soon as I finish with this priority. Thank you for bringing that to my attention.
- Thanks for letting me know, unfortunately I’m dealing with a few time sensitive tasks right now. Once I get my head above water with those, I’ll circle back with you.
- Unfortunately, right now is not a doable time for me. I’m in the middle of a few important tasks, but can address that as soon as possible.
- Sorry, right now I’m tied up with a few tasks but this is definitely important to me. Can we bump this to [suggest new time frame]?
It feels awkward and weird to essentially tell people no or not right now, but it’s a very necessary still to develop as a nurse. Otherwise, you won’t make headway on your responsibilities and will find yourself impossibly behind at the end of the shift.
Looking to prepare for your first nursing job?
The FreshRN® New Nurse Master Class is the first-ever self-guided holistic nurse residency program. This comprehensive program was specifically created for the ambitious newly licensed acute care nurses who want to get ahead of them and build both their confidence and their clinical skills - all while learning how to adjust to the unique lifestyle of a nurse.
To manage feelings of overwhelm as you navigate this massive transition, remember to:
- Recalibrate your expectations to something that is realistic, no idealistic
- Remember that feelings of overwhelm are not evidence of truth; they are a natural byproduct of this complex learning process
- Focus on the immediate small steps you can take; allow this to guide your actions
- Ensure you are addressing your priorities for your unique patient load and learn to graciously tell people “No,” or “Not right now”
- Guide to Overcoming Impostor Syndrome for New Nurses – PDF download
- For The Anxious Nurse: Tips For Nurses Who Struggle With Anxiety – Blog post
- Time Management Tips For New Nurses – Podcast episode
Thank you so much for this! I just started my first job as an RN 2 weeks ago. I was beginning to wonder when that glorious day would come that I would feel capable of actually handling things on my own. This helped. It’s nice to be reminded that it’s all a part of the process, that it gets better. Nice to know that feeling overwhelmed is normal and that it doesn’t mean I chose the wrong career. I’ll get it. Day by day, week by week, month by month… and year by year. I am capable. I am competent. I can do this! THANK YOU, FreshRN ❤
Kati Kleber says
So glad this was helpful! I hope the days are getting better!
Frustrated New RN says
I just linked over to this blog post from facebook, I needed this today. I’m a new nurse on a PICU and you described perfectly my love for my unit but the dread I feel going to work. What I have the hardest time dealing with is the person who says you “haven’t done hygiene care (insert small issue here) on your new admit” (that we just stabilized and got settled) ignoring all the priorities that were addressed and I feel defeated.
Kati Kleber says
That is SUCH A HEADACHE!!! Gah. I felt like that too, even into my career. Unfortunately, there are nurses who care about the little tasks more than the big picture.. who can’t see that while hygiene wasn’t done, you got them intubated and their BP under control. It can be so hard to feel defeated after a long shift and getting a response like that. Those people can’t see the priorities, they just care about tasks, which is a bad sign. I started having to detach myself from those people and giving their words very little power in my mind. I started to only care if the nurses I respected and who knew what was the priority were like “hey you forgot to do ______” – then I’d allow myself to feel defeated. And whenever someone who was nit-picking would say, “So you didn’t do oral hygiene on your unstable admission?” I would confidently says “Nope!” I hope this helps!!!
Hi, i enjoyed reading this blog, I can relate to it a lot as far as prioritizing and time management. I graduated in January of 2016 but didnt start working until December of 2016 in a telemetry unit with only 6 weeks of orientation (not a new grad program). My preceptor was not the greatest to teach me the details and the most important things to know. Everyday I feel scared and dread going to work because im afraid of something happening and not knowing what to do. The biggest problem I have is time management, as much as I try to get better at it, it always fails me and cant never leave work on time. I feel that I am always so focused in trying to stay on top of my game to avoid falling behind instead of paying attention to the most important things which is reading new diagnostic results or digging more into the patients H&P in order to connect the pieces and understand things better about my patients. I also feel pressured in learning/knowing everything because we get sent to ICU within 6 months of employment. All these things have me thinking, and at times I feel Im better off quitting my job to avoid making mistakes and losing my license.
Your not alone… I know exactly where your coming from.
I have been in neuro ICU as a new grad RN myself for three months now. Everyday I dread going to work and use to have panic attacks before work. As soon as I build the confidence that I’m doing good, I get knocked down by a critique from my preceptor. Last shift I felt like I finally “got it” than when next shift came on they noticed a change In baseline that I didn’t and I had to rush my patient off to surgery (an hour after my shift ended). Being a new grad SUCKS and in the ICU in a level 1 trauma it seems there really never is an “easy day.” I’ve had to anxiety meds to help me cope and it barely helps.. I’m praying for the day I finally do “get it” and my days go smoother
I am so happy I found this post and completely agree with the comments above: it’s been hard. I just keep thinking that after a few more months things will suddenly click and I won’t feel like I’m under water. I’m a new grad on a progressive unit and while orientation left me with a bit of confidence, I’m currently second guessing EVERYTHING. Every car ride home my mind is racing trying to think if I forgot anything or if I could’ve done something better. The ride to work is picturing the worst case scenarios that may lay ahead. Really, I just want my peers to trust that I can do the job and won’t think of me as THAT new nurse. It’s reassuring to know that others are having similar experiences, we all have to start somewhere I guess!
It’s really too bad that we all feel like this. I have a great team behind me, that I really love and I know they will always help when I need it. But so many times I don’t even know WHEN or HOW to ask for help. Things seem to come by so fast I can’t even grasp WHAT I need to do for someone. Especially doctors and when someone calls from outside the unit. They speak and use acronyms that I have never heard of. As someone coming from completely outside of the healthcare field into nursing it is incredibly intimidating and frankly terrifying at times. I want to be safe for my patients and do the very best job that I can, and sometimes I’m just not sure what that means. I’m determined to do this well, and posts like this with comments from others going through the same thing buoys my confidence and reinforces that we are ALL new and can only expect so much from ourselves, and all those little extra tasks and distractions are sometimes just that…extras that we do once the core interventions are done. Thanks for the blog and to everyone that comments. Together we can conquer this!
Kathleen Christensen says
Thank you so much for posting this! Basically your description in the first paragraph is totally how I have been feeling as a New Grad in the ICU. I’m almost 8 months in now, and the anxiety has been subsiding but is still there.
I also recently switched to day shift, which is a whole new beast so these time management tips are very helpful. I’m really praying that I reach the day I want to be going to work in the morning, but I’m not quite there yet. So grateful to hear others feel this way and these feelings are normal.
I really needed to read this today. I’m a new grad on a very busy GI PCU and am constantly feeling incompetent in my job. It’s as if I’ve been dropped off I a foreign country and barely speak the language! Time management is hard for me as well and it feels like it’s going to take forever before my confidence in this improves. Thank you so much for encouragement that it will get better!
Kati Kleber, MSN RN CCRN-K says
No problem – I am glad it was encouraging! I’ve got some podcasts that touch on confidence building (FreshRN.com/podcast). I also have a guide for new nurses on impostor syndrome. By addressing that, we can really dig into building our confidence with a firm foundation and healthy motivators for growth. It’s a freebie at: https://kleber-media-llc.ck.page/527888297e
I’m a new grad, I’ve been working in a step-down cardiac-medical unit for 4 months now. At first, I would freak out about the small details, and go home second guessing my every move. I came to learn that it’s the big picture that matters, and that you’re probably the only one freaking out about these minor details. Use your critical thinking skills and your gut feeling, and if you need help, ask. Everything will be okay!
Luzviminda Cantrell says
Thanks for sharing all these experiences and feelings by new nurses . I thought I am the only one getting to these and in a wrong direction of my career ,that most dumb and slow nurse . I always go home in anxiety and often in my dreams having all these pictures of the unit , with palpitations thinking of how I will survive .It is difficult to assess what do I need to know that I do not know . They ask me to ask questions that I need to know which is suppose to be just tell me everything that you are doing and why because I might have the knowledge but it might be partial and by telling me this and that is reinforcing. I am afraid asking a question which outside what I am there for . Thank you for opening your site that help us overcome our struggles and giving us tips and guide.