Get Over the Wall as a First-Year Nurse

Surviving your first year as a nurse will likely be one of the biggest challenges you will face in your career. Almost universally, first-year nurses have days, weeks or months when they feel overwhelmed, inadequate, disillusioned, stressed out or all of the above. If you're thinking, "Was I really cut out for this job?" these tips can help you get through your first year as a nurse with your sanity, confidence and love of the profession intact.

Accept Your Limitations (and Keep Your Ego in Check)

Nursing school can often leave new nurses with unrealistic expectations. "A lot of us nurses are Type A, brainy people who were used to getting good grades in nursing school," says Ashley Flynn, who has been an RN in a surgical unit at Children's Hospital Boston since late 2006. "Nursing school is so hard that when you graduate, you think you know what you're doing." However, you won't know everything all the time, but that doesn't make you a bad nurse, she says.

Don't Try to Do It All

Likewise, new nurses must come to terms with the fact that they may not be able to accomplish everything on their to-do lists everyday. "There were days I ran rampant and didn't eat lunch until 3 in the afternoon, and I left crazy and felt like I wasn't doing a good job," Flynn says. That's when her preceptor would have her write out what she needed to do herself, what she could delegate and what she could leave to the next shift. "You have to learn to accept that nursing is a 24/7 job, and you're only there for 12 hours at a time," Flynn says. "There's always going to be something that you can't be there for or that you can't get done. You have to rely on a lot of other people."

Ask for Help

Good nurses -- whether newcomers or seasoned veterans -- know when to call in reinforcements. For Andrea Kuehn, who has been an RN in the hematology-oncology unit at Cardinal Glennon Children's Medical Center in St. Louis since March 2007, that means asking doctors and more experienced nurses lots of questions. "I'm never scared to ask questions, and I don't care if I'm getting on someone's nerves," she says. "[My] patients' quality of care [is] at stake."

Anticipate Reality Shock

Many first-year nurses participate in structured orientation programs and enjoy low patient loads and lots of help from preceptors and mentors for their first few months on the job. Then reality shock hits when the first-year nurse starts working more independently. "It's common for nurses to go through a slump of discouragement and to feel inadequate and overwhelmed, starting anywhere from their fourth to sixth month on the job," says Stacy Thomson, RN, MSN, a nurse educator/intern coordinator at Wake Forest University Baptist Medical Center. "If they hang in there, they'll feel a greater sense of satisfaction and accomplishment around the nine-month mark."

Separate the Personal from the Professional

One of the biggest mistakes new nurses make is taking things personally instead of professionally, Thomson says. "Family members can be very challenging, and patients in pain can be very irritable," she says. "Professionally, you have to step back and pull out your psychosocial skills and realize that people are in stress, and it's not personal."

Seek Support

Socializing and sharing stories with your former nursing classmates or other new nurses at your facility will help put your struggles into perspective. Hearing a nurse who is a few months further along say, "Hang on, it will get better" or "I've done the same thing you just did" can validate your experiences and provide support, Thomson says.

Remember Why You Became a Nurse

In the end, Flynn and Kuehn both say the wonderful aspects of nursing outweigh the challenges. "There are days you argue or get your feelings hurt or get screamed at, and you go home and don't feel great," Flynn says. But then the next day, a child may draw you a picture or a parent will thank you, making you feel good about that part of the job, she says. "Whether or not we're happy all the time in what we're doing, most of us feel like we were meant to do it," she says.

Adds Kuehn: "I always thought it would be magical, saving lives every day. In fact, it is a very stressful job when you're first starting out. Just remember that everyone has to start somewhere."

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