If you’re newly graduated and just getting started in your NICU nursing role, no fear. I vividly remember the mix of feelings you have right now. It can feel like you’re drowning in expectations, struggling to learn the ins and outs of the company and unit culture, and keeping up with a never-ending flow of patients while somehow trying to remember to take care of yourself and prevent burnout before it starts. The feelings of overwhelm and doubt of whether nursing is really your calling or not creep in but I can assure you that is NORMAL and something we all go through at different stages of our nursing career, but especially at the beginning.
Let’s get into those realistic expectations every nurse should have when starting out and the things to always remember when those waves of doubt come over you of whether or not you’re actually where you're meant to be! This is the list of things I wish someone encouraged me with before diving into my first nursing job.
Here we go...
1. Some people may NEVER appreciate what you do. This is something you are going to have to settle with right away. My thoughts, don't take this to heart. It’s not you, it’s them...BUT you must remain respectful to your patients, their family members & colleagues, even when you feel wrongfully questioned or have your input disregarded. It is going to be disheartening when you have an ungrateful and/or rude patient, co-worker, colleague, etc. but don’t let that change how you provide care. Also remember, respect is earned, not given. It may take some time to establish this with your colleagues when you’re first starting out. If you have a friend or family member that isn’t supporting you in your new role, bring it up to them. Self-advocate for yourself when you can and let go of the rest of the negativity. Don't let this one over-come you. Forward-thinking only. XO
2. Burnout and work fatigue. It’s not as simple as “self-care”. We all face burnout and work fatigue as nurses, but be wary of taking “self-care” advice from those outside of the healthcare field. Unless they’ve walked in your shoes, it’s hard for others to understand the fatigue of a 12-hour night shift, possibly several days in a row. It’s not only physically taxing but emotionally and mentally as you do your part to help your patients and witness both positive and negative outcomes. Prevent burnout before it starts and always leave work at work and truly live life "off the clock," on your days off. If you notice burnout creeping in, make some changes. Either professionally or personally. Try a new role on the unit, look into an educational opportunity, attend a conference, network, challenge yourself, apply for a new unit or hospital, etc. Nursing is far too expansive for you to live in burnout. Don't sink into it, get ahead of it.
3. You may love your job at first, or be in love with the idea of a certain specialty, then grow to dislike it. Yep! That can happen! Ultimately, life is all about growth and change, so don’t be afraid of it! It’s okay to start off in love with one specialty and then as time goes on, grow to dislike it for whatever reason. It doesn’t mean that you failed to identify your passion or that you’re in the wrong profession altogether. Make a list of the pros and cons of your unit/specialty and then work toward making a change if you feel that the cons outweigh the pros for you. Floating to different units and taking a travel nursing assignment helped solidify in my mind what I wanted to stick with as it gave me a broader perspective on how other hospitals, units and specialties operate. If you’re falling out of love with your job, I encourage you to make a BIG change and take a travel nursing assignment. A change of scenery and operations might help you determine where you feel led to be more long-term.
4. You will work with some very difficult personalities. All different people with all different backgrounds and aspirations work in healthcare. Not everyone thinks like you. This is not always a negative. In fact, I think this is something that can move you forward in your journey of professional growth. I have worked with plenty of nurses and doctors who I initially STRONGLY DISLIKED but grew to LOVE like no other. Remember, someone could just be having a bad day (or even a hard season of life) and bring that burden to their shift(s) with them. Or maybe you guys just don't jive. That's ok. Give yourself enough time to get to know each other before judging them and find ways to work better with them and not against them.
5. Work culture can affect you professionally AND personally. Work culture is HUGE and a big thing you should ask more about during your job interviews! Every place you will work at will have a different culture so having insight into it before you start will help you adapt and contribute more quickly. For example, if you have always preferred to work alone and problem solves quietly, a culture that embraces community discussion, bouncing ideas off one another, and problem-solving might feel intimidating to you at first. Instead of miserably cooperating, switch your mindset to thinking this may actually be the best thing for you to continue to grow as a well-rounded nurse both personally and professionally! Embrace what you want to see developed in your unit’s culture and showcase it on a daily basis with a leadership mindset. There is always room for improvement when it comes to healthy work culture.
6. Rome wasn’t built in a day (or a year). Work experience & professional development take time. Be ambitious and do those extra certificates, conferences, and classes but don’t get hung up on wanting to know it all from the start. It took me 3 years to feel "competent" in my Level IV NICU, and even after 9 years, I have moments when I make mistakes and learn something new.
There will be things you don’t know, so get comfortable with being uncomfortable. Ask questions, be nosey, get involved, and take initiative. Every shift is an opportunity to dive deeper, become more confident, and make a lasting impact on your fellow shift workers and patients. I have been in my nursing role for over eight years and still seek out leadership and professional growth opportunities everywhere I can. A simple way to start is to seek out conferences that you can join or certificates that you can earn to solidify and expand your nursing knowledge!
7. Prioritize your own personal "work" so you can show up as your best self This is vital! If you’re struggling personally, it is hard to be 100% present during your shift and that space is where mistakes are bound to start happening. I wish someone had told me earlier that it is not only “ok” to go to therapy but therapy is actually extremely helpful to process what I am feeling and thinking as a healthcare provider- all of the struggles, disappointments, and fears that come with being a nurse. Therapy, meditation, and scheduling time to move my body and make fun plans with family & friends are all ways that I put my well-being first so that I can be the best version of myself and bring that good energy with me to my shifts.
Research shows that unchecked mental fatigue results in an inability to concentrate, irritability, stress, depression, frustration, chronic diseases, forgetfulness, and an increase in simple mistakes. What's more, it spills over into your relationships including family, friends, co-workers, etc. If you’re not sure where to start or you’re struggling with mental fatigue specifically, check out my 10 Tips for Preventing Mental Fatigue episode on The Cellfie Show!
8. You will hit a professional plateau. Shift. Think about what’s next and how to challenge yourself in a new way. We all hit that plateau at different points in our careers. For some of us, it happens within a few months of starting in a nursing position and for others, it can be years before we start to feel stuck. You’re never stuck as a nurse! There are so many options for you to make big moves and changes in your career, whether that includes travel nursing, changing the unit you work in, switching hospitals or even taking your career to the next level by going back to school to get your masters or become an NP. One of the best parts about nursing is its flexibility of it and the varying job options you can have with your degree. So if you decide that bedside isn’t for you anymore, there are other nurse occupations to look into. Check out my blog 51 Nurse Jobs to Consider for some nursing job insp!
9. Doctors make mistakes too We are all human and make mistakes. There will be high-pressure situations that will require immediate decisions, but don’t blindly follow orders under pressure that you feel uneasy about for whatever reason. It truly takes a team to provide our patients with the care they deserve, so don’t be afraid to speak up when you think there might be a mistake. Listen to your gut and trust your teaching. Question orders (especially if you find yourself working in a teaching hospital with medical students, residents, fellows, etc.) when you feel like something isn’t right and double-check your information. It can be so easy to get caught up in emotion and blindly follow a process, but you have to be strong and speak up to best help your team and your patients as mistakes in healthcare can mean the difference between life and death for those we care for in our units.
10. You will inevitably face ethical dilemmas You may have times you disagree with the medical team you’re working with regarding a patient, a doctor’s specific order or plan of care. If you feel strongly one way on how to handle a patient’s care (and they feel another) it can become an ethical issue. One of the hardest ethical dilemmas in my opinion that can come to you as a nurse includes knowing how much or how little to share with a patient and their family.
Do you continue care on a patient whose outcomes are detrimental despite family wants?
Do you continue life-saving care on a patient per legal team's notions?
Do you align with the medical team providing hope even when outcomes are questionable?
Do you hold a secret a family member provided with pertinent medical care information?
These questions and others are ethical issues that you will inevitably face in your career. Certain codes and medical mistakes also become those life and death scenarios that can quickly become an ethical issue. Use your chain of command. Charge nurse, manager, CNS, director of medical, etc. All hospitals offer ethical committees, so don’t be afraid to utilize them.
11. You are the coordinator of the party Yes, you! Think of yourself as the host of the patient party. As the nurse you’re the direct link from the patient to their family, MDs, NPs, surgeons, consults, RTs, therapists, social workers, etc. while they are under your care. This is the time to remember that you are your patient’s best advocate and help ensure that your patient is given all medical information, education and options so that they can have the autonomy to make the best decision that they feel the most comfortable with. This will obviously look different depending on your specialty/unit, but the overall point is the same. You are the one who is coordinating others that surround your patients and keep all the balls in the air. It’s a vital position as giving correct and timely information to the patient’s “party” will set the standard for their continued care.
Real tea? You may form a huge love-hate relationship with your nursing career. You will have those hard days that leave you in tears on your commute home, but you will also have the days where you leave work feeling proud of yourself for helping to save someone’s life.
On your hardest days, don’t forget the good days that you’ve had too and that have shaped you into the strong nurse and person you are today. Your talent and expertise that you bring to the table is needed in nursing more than ever before.
Leave any other questions you have about starting your new nursing career in the comments below! XO
Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, Sponsored Capella University MSN student, a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or firstname.lastname@example.org