I can still remember my first shift. . .
I arrived to the Neuro ICU about 5 minutes late, sweating, out of breath, and flustered . . . not to mention nervous, scared out of my mind, and excited!
What a way to start my career as a nurse, right?
My initial plan was to arrive 30 minutes early, look up my patients, and try to feel prepared for the shift . . . things didn’t work out that way and I ended up stuck in traffic for nearly two hours.
Will I Be a “Good” Nurse?
Last night I was reading the Show Me Your Stethoscope Facebook group page and saw this honest and humble post from a new nurse:
My initial thought was: Wow, I wish I could be her preceptor. We need more nurses like her.
This post is full of so much humility, honestly, and excitement.
But then I began to read the comments and found that there were MANY nurses and nursing students that struggle with the same feelings of doubt, fear, and anxiety . . . some to the point of not even applying for a job after finishing nursing school and passing the NCLEX®.
So I decided I wanted to make an episode to address not only the fact that it is normal to have these fears but why it is important.
Tomorrow I start my very first job as an RN. Is it normal to feel terrified or scared that I won’t be able to do it or that I won’t be a good nurse?
Is It Normal to be Terrified for Your First RN Job?
In a 2008 study by the Journal of Advanced Nursing they found the following:
New nurses often identify their initial professional adjustment in terms of the feelings of anxiety, insecurity, inadequacy and instability it produces.
In other words, most new nurses use words like:
to describe their feelings about their first nursing job.
It is scary and hard to make the transition from “theory” to “real life”. It is hard to take all the knowledge you have gained in nursing school and try to figure out how to apply it to your role as a nurse.
A Few Words of Confidence
It is important to look at everything you have done to reach the position you are in . . . to reach a place where you have secured your first job as a nurse.
- Been accepted to nursing school (31-37% of qualified candidates are rejected)
- Passed nursing school (attrition rates are as high as 33%)
- Passed the NCLEX® (only 84% of first time US test takers pass)
- Been offered a job (my hospital gets 400-800 applications for only 20 ICU spots less than 5% are offered a job)
Based on these numbers . . . you are one of only 3 out of 100 nursing students who start nursing school that has been offered a nursing job!
That’s impressive . . . you are literally the cream of the crop. Be confident in YOU.
Are You Ready to be a Nurse?
In a word . . . NO . . .
But . . . you are QUALIFIED
Let me expound.
There is a massive canyon that exists between nursing school and BEING a nurse.
This canyon exists for many reasons . . . nursing units are specialized (you can’t learn everything NEURO in nursing school), you haven’t been exposed to very much clinically, it is impossible to know everything.
Good hospitals have identified this canyon and have implemented preceptorship or internship programs to help new nurses transition.
This time is important to help you bridge this gap. A 2003 article in Journal of Nursing Education found that internship provided new nurses with the ability to find their own rhythm:
Finding a rhythm brought graduates confidence and feelings of accomplishment, and self-reflection emerged as an important and integral part of the transition process. Despite the challenges and stress of orientation, graduates found great meaning in their work, and most expressed readiness to be on their own by the end of 12 weeks.
RELATED ARTICLE: I’m a Little Bit Scared to Share This #vulnerable
Are You Growing?
Regardless of how long you have been a nurse there will be many shifts that you simply feel over your head.
Growth occurs when you reach the EDGE of your comfort zone and then take a step into the dark.
"Growth occurs when you reach the EDGE of your comfort zone and then take a step into the dark."
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There will always be shifts, patients, situations, etc that require you to grow. This is an integral part of life and nursing.
Nurses that stop striving for growth are dangerous.
What I am trying to say is . . . starting this new job is the step into the dark that will allow you to grow. You can’t stay a nursing student forever (and who would want to).
As you make the scary step into the hospital for that first shift you a literally growing and becoming a better, stronger, and more confident nurse.
Would You Turn Down $5,660?
Some new nurses mentioned that the fear and anxiety of starting the new job has stopped them from applying for jobs in the first place.
Let me offer a thought on this.
The average nursing pay in the US is $32.66 an hour.
That comes out to $5,660 a month.
That means that if you delay your job search by even just one month you are essentially turning down $5,660!
And each month you delay working means that you delay your career goals by a month.
And, get this, by DELAYING starting a new job you DO NOT get rid of the anxiety of STARTING.
The same fear, anxiety, and doubt will exist no matter when you start your first nursing job.
Embrace the Fear
I know, I know, this is the sappy stuff, but I mean it . . . learn to embrace the fear of being a nurse.
We all learned in psychology about eustress vs distress . . .
Eustress is a form of stress that motivates and moves us. Learn to embrace the fears associated with starting your first nursing job and face them head on. You can use the fears to help you be more:
This means you respect what it means to be a nurse . . . it’s more than an abbreviation.
RELATED ARTICLE: Landing Your First Nursing Job Right Out of School with Nurse Beth from NurseCode.com
6 Tips for Your First Job
Here are 6 quick tips and areas to focus on to help you excel in your first nursing job:
- Develop a rhythm (focus on charting, timing, eating, etc)
- Organize your life around nursing (learn when to sleep, when to rest, how to make life work as a nurse)
- The Job! (during internship . . . focus on learning the job)
- How to talk to patients, docs, and families (this is a big part of the job)
- Hospitals are small places (people will get to know you, make a good name for yourself)
- Respect others (CNAs, RT, housekeeping, maintance, docs, everyone)
Nursing is a tough profession . . . it takes a lot to be a nurse and it is hard to transition into that first job . . . but it is possible and being nervous is a sign that you respect what you are doing.
|Today, we’re going to talk about feeling anxious, feeling scared for that first nursing job. This is something that many people feel. You know, it’s terrifying making the transition going from student nurse where you have the protection of your school, your clinical instructor, your preceptor, into being the nurse. Okay, so we’re going to talk about that today. What made me really start thinking about this was a post in the Show Me Your Stethoscope Facebook group. If you guys aren’t members of that group, head over there and become a member of that group. There’s about 700,000 nurses, nursing students, and healthcare providers, and it’s just a huge group where you can get support.|
|I want to talk about a post that popped up there last night. This brand new nurse said, “Tomorrow, I start my very first job as an RN. Is it normal to feel terrified or scared that I won’t be able to do it or that I won’t be a good nurse?” Now, within just a couple hours, this post had garnered nearly 500 likes and almost 100 comments. Okay, and I want to talk about some of these comments, but before we do that, I want to address the very first part of this question.|
|I really think this is very important, you guys. I think this is such an important topic. I want to talk to you about why you should be scared, why you should feel a little bit terrified and a little bit scared, and why it’s normal and how to deal with that. That’s what we’re going to really talk about today.|
|All right, so first of all, is it normal to feel that I won’t be able to do it or won’t make a good nurse. In a 2008 study by the Journal of Advanced Nursing, they have the quote that, “New nurses often identify their initial professional adjustment in terms of the feelings of anxiety, insecurity, inadequacy, and instability it produces.” Not only is it normal, but there’s studies out there to kind of show that this is how most new nurses feel when they start their job, okay? They use words like “anxiety,” “insecurity,” “inadequacy,” “instability.” It’s a very trying and hard time. Why is it so hard? Well, like I said earlier, you’re going from this role of student nurse. You know, you used to be able to walk into a patient’s room, you know, maybe once a week, maybe twice a week, depending on how often you had clinicals, and you could say, “Hey, my name is John. I’m a student nurse, and I’m with my preceptor, Ashley, who’s a very experienced nurse. I’m going to be taking care of you today, and we have Ashley here too.” You really go from that role into walking into the room and saying, “My name is John. I’m going to be your nurse today.” That’s really scary.|
|It can be very terrifying making that mental adjustment in our mind that we don’t have the backup of the university anymore. We don’t have the backup of our instructors, and we don’t have that instructor that’s roaming the hospital halls if we have any question that somebody can’t answer. We really switch from this position of theory of sitting in a classroom in your sandals and your shorts learning about heart failure to, “Okay, I have this patient who’s massively overloaded, and they’re not urinating. What am I going to do? What do I do next?”|
|We really go from that theory portion of nursing and what is nursing, what is heart failure, what is a patient, how do I talk to a patient, and we go to the real life where we are the nurse. Like I said, within just about an hour, or a couple hours, this post had garnered 93 comments. Everyone, every single one of the comments said that it’s perfectly normal. One person said it’s “1 billion percent normal” to feel these feelings that you won’t be able to do it. One person mentioned that after 40 years as a nurse that every time they change a job, they get those same feelings of anxiety. Another commenter said that after 18 years of Med-Surg they switched to ICU, and it felt like being a brand new nurse again.|
|Another person even mentioned that they were sick and they were out for a couple days. When they came back to the job, it was those same feelings of being new. This is very normal. I remember my first day on the job. I had already interviewed with the hospital. I had been up there, met the nurses, met a couple of the nurses. I hadn’t met my preceptor yet. I had met the manager. My first night shift, I showed up, and I didn’t even know what my preceptor looked like. I was terrified. I had actually gotten there late as well because of traffic. I mean, I had given myself an hour and a half to drive downtown, but even with that much time, I still arrived there late because there had been an accident. I had no clue what it was going to take to get there, so I showed up right at 7pm, you know? Didn’t get time to look up my patients. I’m just freaking out.|
|I was really lucky with my preceptor, so I was freaking out. I was obviously very stressed. She said, “It’s okay. Take a minute. Get organized, and then we’ll do this.” I remember that first day still, even years later, and how nerve-wracking it was. You know, I was primped, and I had my hair all done. I was trying to look really confident. I was trying to be very confident in what I was doing so I could do well, but inside, I was freaking out. I was terrified. I want you to listen to these words of Ashley Atkins when she talked about her first day on the job.|
|As you can see, Ashley, too. This was a video of her on her way to her first job that very first day. You can see that you’re excited, you’re anxious and you’re happy and you’re excited, but you’re also terrified because you really don’t know what to expect.|
|Okay, and those were the words of Rona, or from [Hey-Rona 00:06:05] and you can see that the same thing, the nervousness. It’s not even necessarily the nervousness with yourself, but it’s about being RN. You know, having that behind your name and being that nurse now. Now, I want to give you a couple of words of confidence, okay? You talked about, and I hope you understand that it is very, very normal, but I want to give you a couple of words of confidence as well. I want you to think about everything that you’ve accomplished and everything you’ve done to get to this point of having this job as a new nurse.|
|First of all, you’ve been accepted into nursing school. The National League of Nursing reports that between 31-37% of qualified nursing school applicants are rejected for admission. Just getting into nursing school is incredibly difficult. Nearly 40% of qualified applicants aren’t even admitted into nursing school. You know, we know of nursing schools that have 2 or 3-year wait lists where it’s increasingly difficult to even get into nursing school. You’ve accomplished that hurdle.|
|Okay, another study by the Cincinnati State College states that there’s about a 67% graduation rate, which means about a 33% attrition rate, meaning that of those nursing students that get into nursing schools, 33% are failing out or never make it to graduation. You’ve already accomplished those 2 hurdles. That’s a huge number. 33% of nursing students aren’t even graduating nursing school.|
|All right, now let’s talk about passing the NCLEX. You got into nursing school. You passed nursing school. You graduated. Then you pass the NCLEX. Now, in 2015 as a whole, only 84% of US test-takers passed on their first try, and only 70% overall passed … You know, that’s included foreign-educated nurses, repeat test-takers, so the total overall pass rate of the NCLEX was only 70%. You’ve accomplished these 3 huge hurdles. You got into nursing school, which we all know how difficult that is, passing anatomy and physiology. You were able to pass nursing school, you know, where 33% don’t even achieve that hurdle. Then you pass the NCLEX, so you’re one of only 84% of people that even get to that part, or one of 70% overall.|
|Then you were offered a job. Now, I want to talk to you about my ICU internship. The hospital that I interned at received between 400 and 800 applications for about 20 spots. At bet, you have a 5% of getting a job in the ICU internship. Now, it’s different for Med-Surg or for different places, but … And, that would be different for smaller hospitals, possibly, but for this hospital that I interned at, we got between 400 and 800 applications of qualified nursing graduates that wanted to work at the hospital. If you think about that, at best you have a 5% chance of even getting that job.|
|Now, based on those numbers, so based on those numbers of 33% attrition rate, 84% passing on the first try US-educated nurses, and only 20 out of 400 applicants getting a job, the fact that you have a job now, the fact that you’ve been offered a job and you’re going to be able to start a job means that of 100 people that got accepted into nursing school, that at best, you’re one of only 3 that’s being even offered a job. 100 people will start nursing school. 33% are going to fail out. Only 84% are going to pass the NCLEX on the first try if they’re US-educated. Only 5% are going to get a job.|
|That means that out of those 100 people that start nursing school, only about 3 people are being offered a job based on these numbers. Think about what you’ve been able to do. I want that to give you confidence that you’ve already done probably the hardest part of all of this, of just getting this job. I know it’s nerve-wracking. I know it’s hard. I know it’s difficult to start that job and it’s scary, but think about it. You’ve already done the hardest part of all of this, which is just getting to this stage of your life. For a lot of this, nursing is a goal, nursing is a passion. It’s something that we’ve dreamed about for a long time; it’s not just this thing that we go and do. It’s this thing that we’ve wanted to do for so long, and now you’re here. I want that to give you some confidence, that to give you some pride and some energy and some determination to kind of conquer these fears that you’re having in yourself and this self-doubt that you might be experiencing, okay? That’s what I really want you to get rid of, is that self-doubt.|
|Let’s answer this next part of the question, is, “Are you ready?” Are you ready to be a nurse on your own? The easy answer to that question is no. No, but you are qualified. You’ve gone through all these different hurdles, these different hoops, and you’ve reached this portion of the nursing journey. Are you ready? No, not really. You’re not ready to be an on-the-floor nurse by yourself taking care of patients. You are qualified. There is a massive canyon that exists between nursing school and being a nurse. Between learning the theory and being the nurse, there’s an enormous gap.|
|Units are specialized. You don’t have clinical experience yet. Translating from the book to real life takes a lot of time. To help bridge this gap, most hospitals offer orientations and preceptor programs. As I mentioned before, I was really lucky to have an amazing preceptor and a good unit and supportive management, that really tried to help us excel. You know, part of my internship included classes where we went and met with all the other interns and kind of developed this bond of interns that were in different floors, and we got to talk about the experiences that we were having.|
|Most hospitals have that. There’s an article from the Journal of Nursing Education in 2003 that said, and this is a quote. It says, “Finding a rhythm brought graduates confidence and feelings of accomplishment and self-reflection emerged as an important and integral part of the transition process. Despite the challenges and stress of orientation, graduates found great meaning in their work, and most expressed readiness to be on their own by the end of 12 weeks.” Orientation and preceptor programs are very important. If you haven’t found a job yet. If you’re one of those that’s still looking for a job yet or still afraid to apply, try to find a hospital that offers orientation program for new grads, and hopefully you’ll be able to find one that has a longer program. Generally, those that have longer programs means you’re going to have a little bit more support. You’re going to have a little bit more education available to you as you’re working through the program.|
|Even as you grow as a nurse, even as you finish internship and everything … I remember the shift that I was going to be on my own for the first time. I didn’t have a preceptor anymore. She wasn’t there, and I was there on my own as Nurse John taking care of patients without a preceptor at all after I had finished internship and everything. I remember coming up the elevator. I got off the elevator, and the charge nurse for the day shift was coming on. I said, “I don’t think I’m … Are you sure we’re ready for this, to be taking care of patients on her own?” She kind of laughed, and she understood what I was saying and everything. She kind of said, “You are ready. You’ve done this. This is where you’re at now in this journey. We’ve all been through it, and you’ll be able to do this. Rely on your staff. Rely on your charge nurse, and you’ll be able to make it work.”|
|Through that experience, I learned. I was terrified. Let me tell you, even years later, there’s going to be very first shifts where you won’t feel a tad bit over your head or a tad bit nervous. Growth occurs as we reach the very edge of our comfort zone and then take a step into the dark. I want to say that one more time. Growth occurs as we reach the edge of our comfort zone and then take a step into the dark. All right, it’s scary. It’s terrifying to walk into the hospital that first time. You don’t know anybody. You don’t know what the job’s going to entail. As you take that step into the dark, you’re taking that first transition step, bridging that gap, between nursing student and nurse. That step’s required to get there and to achieve that goal. You can’t be a practicing nurse until you take that first step into the hospital. There will be very first times in your career as a nurse, hopefully, that you’re feeling just super comfortable, super confident. What I want you to do, an important question I want you to ask yourself as you go through this journey is, if you’re starting to feel very comfortable, say, “Am I growing?” I want you to ask yourself, “Am I growing? Am I becoming who I want to be as a nurse?”|
|If you start to feel comfortable, I would challenge you to do more to get yourself a little bit uncomfortable again. One of the people we’ve had on this podcast before is Nurse Nicole, and one thing I really respect about her is that she made a goal to get 1 certification every single year. As she’s done that, she has so many certifications because she’s continually learning, and now she’s doing nurse practitioner school. She’s just been continually learning her entire journey as a nurse. It’s important to feel a little bit uncomfortable. If you start feeling cozy and comfortable and just going to work and playing your part, I think it’s time for you to grow more.|
|You don’t need to worry about those certifications and becoming a nurse practitioner and all that right now. What you need to do is you need to get your feet wet, get your groove, and then start kicking some ass, and then start becoming an incredible nurse. To do that, you got to take this first step. Then you’ll start to feel comfortable. As you start to feel comfortable, then you start looking at growing again.|
|One thing I want to talk about here too is that there are several nursing students that have talked about waiting to apply for their first job because they’re so scared. They’ve passed the NCLEX a month ago when they’re just so scared to apply for a job because they’re so scared about what it’s going to be like. I want to talk to you, just one thing really quick about this. The average nurse salary in the US is $32.66 an hour. Okay, so every month that you wait to apply for a nursing job, you’re essentially losing $5,660. Think about that. Every month you wait, that’s like throwing $5,000, $6,000 away.|
|$1,200 a week or whatever that is, you’re really, essentially, throwing $1,200, $1,200 a week away by not applying for a nursing job because the more you delay that, the more money you lose. Not only that, you delay your career goals by 1 month. You won’t achieve the CCR and you won’t become a CRNA. You won’t become a nurse practitioner as fast. It’ll take you 1 month longer. You do not avoid the fear and discomfort of starting your first job by delaying it. No matter when you start and no matter how long you wait, you’re going to feel uncomfortable that first job. You cannot avoid that by delaying it. You lose a month of paying down your loans without interest.|
|Then even more importantly, maybe most importantly, is you got to live with your mom for 1 more month. If you were living with your parents during nursing school and you don’t get a job and you don’t have the money to pay off your loans and everything, you’re going to be living with your parents for 1 more month.|
|Really quickly here, I want to talk about a couple more things. I want to talk to you about how to approach your first job. I think this is really important. The first thing I want to tell you to do, and I have just a couple suggestions here. The first thing I want to tell you to do is to embrace the fear. We know from psychology and from anatomy and phys. and from nursing school, we learned about eustress versus distress. The difference between eustress and distress is that eustress is good. It helps move us toward good actions. It keeps us alert. It keeps us pushing and doing what we should be doing, where distress brings us down and makes us not want to do things. I want you to embrace the fear of starting this new job and allow it to help you become more cautious, allow it help you be more alert, and allow you to be more aware in what you’re doing.|
|I think that you can use the stress and the fear of starting this new job to be a better nurse. Also, I want you to never attempt to be a know-it-all. You’ve learned a lot. You’ve learned a ton in nursing school, no doubt about that at all. You’ve learned so much, but never try to be a know-it-all. There’s so much more to learn. There’s so many little nuances of nursing and of healthcare and the body that you can never know it all anyway. Never try to be a know-it-all. The scariest interns and the scariest new nurses were always those that pretended to know it all and never asked questions.|
|I want you to make connections. I want you to make connections between things. When someone says, “We never run this fluid at this rate,” say, “Why? Why? Why?” Just start trying and asking all those questions. My 5-year-old son asks why so often because he’s making these connections in his brain. He’s learning about the world, and I want you to be like that; be like a 5-year-old. Absorb everything you can and always be asking why and how.|
|As you’re starting this new job, I want you to focus on 6 things. I want you to focus on developing a rhythm, organizing your life around nursing, focusing on the job, how to talk to patients, docs, families, remember hospitals are small places, and respect others. Talk about those really quickly again. First of all, I want you to focus on developing a rhythm. How are you going to chart? What time are you going to show up? When are you going to eat? When are you going to go to the bathroom? Start really developing those parts of the job because as those little nuances come together, it’s going to give you more time to focus on the patient and more time to focus on the care. I want you to really take the time required to really learn about how to be better at charting, how to be better at your assessments, how to be quicker with these different types of things.|
|Number 2, I want you to organize your life around nursing. Now, you’re becoming a nurse. You’re a professional nurse now, and so that’s going to affect your life. If you’re a night nurse, you need to organize your day before your first shift, your shift after your last shift. You need to organize your life around nursing so that you’re organized, you’re alert, you’re awake and aware for these shifts that you’re going to be doing. I also want you to focus on the job. During orientation time, your whole life needs to be nursing. It’s almost like nursing school again.|
|You need to tell your family, your friends, like, “I got to get through these 12 weeks. I got to learn everything I can. I got to get my rhythm with nursing,” and I want you to really focus on the job. That’d be your number 1 priority.|
|I want you to learn how to talk to patients, doctors, and families. These are skills that are really hard to learn, and it is very different. It’s not the same as just having a normal conversation when you’re talking with a family whose family member has just died or whose grandma just got diagnosed with cancer. Having these conversations is very difficult, so learn some of those skills and how to have those conversations.|
|I also want you to remember that hospitals are very small places. There’s not a lot of staff at a hospital, honestly, and so very quickly you’ll start to know a lot of the different workers in the hospital. I want you to keep in mind that they are small places and that you need these people to build a network of professionals that can help you provide the best care for your patients. Be a helper to other people. Be useful to other people. Don’t spread gossip. Don’t get catty. Don’t get like all these things as you’re starting your first job.|
|I also want you to respect others. I want you to respect your CNAs. I want you to respect your respiratory therapists, housekeeping, maintenance, food service, the doctors. Things are going to happen in the hospital, and you’re going to have to rely on each of these people, and it could be the strangest situation where you’re going to really need housekeeping on your side. I want you to respect these other people because they’re doing their job, and you’re doing your job, and the whole goal of everyone’s job is to take care of the patients and the families. Respect others. Respect what they’re doing so that we can do this the best way, so that you can have this big group of allies that are helping you and they’re helping the patient.|
|I want to end with one more thought. The scariest new nurses and nurses in general are those that never ask questions or walk into the unit with a lot of hubris. This false sense of knowing everything. I want you to remember this. Nursing is a team sport. You’re not that smart. You just don’t know everything. Nobody does. None of us know everything. We all need each other to make this whole thing work. We’re all in this together. I know I say that a lot, but we are, guys. You guys, we’re all in this together, and together, we can make this all work.|
|Just to end, and to end my thoughts here, I want you to just understand that everyone feels scared for their first job, whether that’s nursing or anywhere, but there is a lot of stress on us as nurses, and new nurses to want to take care of our patients and to do the best that we can. That’s really all that you can do, is do your best. Be confident in yourself, and ask a lot of questions.|
|The biggest thing that I want you guys to keep in mind, and the biggest thing that I want you to remember, is that growth occurs as we reach the edge of our comfort zone and then take a step into the dark. Starting this first job is this step into the dark that’s required for you to become the nurse that you always wanted to be. You should be a little bit scared. I think that’s good. I think that’s healthy. I think that’s positive. I want you to just have confidence in yourself and know that you can do this. If you guys need anything, we’re always here for you. We’re here to help you succeed as a nursing student, as a new nurse, and in life. I appreciate everything that you guys do, and just know that we’re all this in together, like I always say. We’re all in this together. Make sure you head over to nrsng.com/freebies. Get signed up for our free PDF cheat sheets and references and resources.|
|Become part of the community. We’re all in this together. Be sure to share this with somebody that might need it. If you have time, share the podcast. It’s really easy to do on your phone. Leave a review. We love you guys. We appreciate everything you do. You guys know what time it is now; it’s time to go out and be your best self today. Happy nursing.|
Date Published - Apr 25, 2016
Date Modified - Jun 25, 2018