You have just graduated, are nearing graduation, or have just passed your NCLEX. You have a shiny new, engraved, Littman stethoscope ready to go, your scrubs are pressed, and you are breaking in your new nurse shoes. Hopefully, you have a job and you are motivated to begin. The following is some general, but very real advice, no one will ever give you until now. Best of luck in all of your endeavors, you’ll do great.

Map out your schedule

Some fresh nurses have never worked a full-time job before graduation. Everyone talks about the joys of the nurse schedule. Yes, there are some serious benefits, but every new nurse should understand the intricacies before she or he begins.

 Hours per week: A “normal” schedule to sign on for is 36 hours per week. Some hospitals are making nurses pull a 40-hour per week schedule, so beware of this and fully examine all aspects before signing on. A 36-hour per week schedule comprises 3 shifts per week. A 40-hour per week schedule may be a salaried position and comprise 3 shifts per week for 4 weeks and 4 shifts per week for 2 weeks. This type of schedule is made on a 6-week grid.

Shift: A new nurse will typically begin on night shift or day shift. If your job offers rotating shifts, make sure you understand what rotating involves. I suggest actually mapping out your first schedule to help understand the time you will need to be sleeping and recovering. For instance, if you work a Friday night, you will need to sleep Friday during the day and Saturday during the day to recover. So, by working one Friday night, you lose two days. This is why rotating shifts can be extra difficult. Even if you work only dayshift, you will likely be so tired after one shift that you will need to sleep and relax half of the following day. Even now, as an experienced ICU nurse, the 12-hour shifts make me so tired. I always try to allow myself to sleep in the next day if I’m not working another shift.

12-hour shift: As mentioned above, a 12-hour shift can make you really tired. Most hospital jobs will hire on to 12-hour shifts. However, if it becomes too much, there are other jobs that will hire on at different intervals, like PACU, ER, and outpatient clinics. So, just know, there is always another option.

Weekends and Holidays: If you start working in a standard hospital job, you will be working weekends and holidays. This will become a new normal for you. I typically really enjoy the camaraderie on holidays. We all bring in food and make the best of being together on Christmas. However, if this isn’t for you, there are plenty of other jobs in nursing that require no weekends or holidays.

Ask questions, but you’ll never know it all

I sound like a broken record, but a new nurse must ask questions. I still ask a ton of questions. There is nothing embarrassing about asking questions, but what is embarrassing is an adverse outcome because something wasn’t questioned. I am most skeptical of a new nurse who knows it all; it is a recipe for disaster.

On the flip side, you may ask a lot of questions and be very eager to learn, but it’s important to know you will never know everything right away. I used to be very uptight about learning everything. The truth is, being a proficient bedside nurse comes with time and experience– it can’t be rushed. So, as a new nurse, it is your job to build a solid foundation. If you don’t know the answer to something, know how to find the answer. A solid foundation will carry you through.

You have more resources than your preceptor

Hopefully you have a great relationship with your new preceptor. However, this should not be your only resource. One year into ICU nursing I switched from a cardiac medical ICU to a cardiac surgical ICU. My first day on the job I was told I would be recovering a complex cardiac surgery. When I asked for advice, all I was told was to “give fluid.” I was incredibly nervous.

Now this “sink or swim” method of teaching is not the best idea. But, I was urged to find my own way out of necessity. I logged on to the hospital portal and learned how to access academic research. I watched YouTube videos on CABGs and valve replacements. I read UpToDate and The New England Journal of Medicine for any treatment I did not understand. I listened to podcasts and read nursing forums. Then, I located the most experienced nurse on the unit and asked him to stop by my room when he could to quiz me and check my work. Because of this active learning, I became a much better nurse, faster. Passive learning, the equivalent of reading a book one time, is not nearly as effective.

Especially in this day and age, the resources for FOAM (free open access medicine) are endless. These are some of my favorite websites and podcasts related to critical care: The Maryland Critical Care Project, FOAMCast Podcast, and EMCrit. Another that provides great info for a beginner nurse is FRESHRN. My favorite podcast featuring real down and dirty nurse stories is the up and coming National Scrubs Radio (I was just interviewed in their most recent episode).

I’m not going to lie, sometimes these situations completely suck, but it is really all about what you make of it and what you learn from it. The learning as a nurse never ends. So, if you are looking for a job to sit back and be pretty, nursing isn’t the profession for you.

Be humble – You may know some things, but can you save a life?

When I graduated with my BSN, I would sometimes know obscure facts about things that experienced nurses did not. Before I knew how to be a nurse, I considered these obscure details to be important and thought I was really smart for memorizing them. Then, I got a taste of the real world and realized a lot of what I was taught in nursing school didn’t mean anything. You’ve probably heard that providers who get the best grades aren’t typically the greatest at the bedside. In my experience, this has been mostly true (there is always an exception). Now, I’m not telling you to get low grades, I’m just saying that many times it does not translate to the bedside. Just because someone knows every interleukin and cytokine in the immune system, doesn’t mean they can save a dying patient – some food for thought.

Make friends, sometimes bribery is required

You are going to need some friends and communication is a huge part of the job. This means, if you have a personality that does not attract people, you might have to earn your friendships a little more. Offer help to others regularly and bring a baked good for an icebreaker. Nursing is a club. We are a welcoming bunch, but if you act like an arrogant asshole, it will follow you at your job. Having friends is absolutely imperative to survival. A good team makes the difference between a great day and an utterly miserable day. If you’re still not making friends after six months, evaluate whether your unit is toxic, or if you are being toxic. It may be an opportunity for personal growth.

Crying is okay, but be careful

Here is the reality about crying. We have a tough job and it can be painstakingly sad sometimes. You will experience emotions and situations that 95% of the public will never understand on a regular basis. Showing some vulnerability in front of patients and families is okay­ – we are human and I fully promote letting your wall down a little. However, if you are going to full on sob, you need to go into the bathroom, or find a place to cry. Do not do this in front of the patient or family, because at that point, the attention is turning on to you, when it should be on the patient.

I want to clarify, that it is important to acknowledge your emotions; do not bury them because they will implode in the most terrible ways at some point if you do. A better way to acknowledge them is to compartmentalize. The crying will begin to take place in your car on the way home, after your shift with your best nurse friends, or whatever way works for you. You will learn to retrain your emotions. Where you once thought dying was the worst possible outcome, you may tell yourself that it’s very sad, but you had the privilege to make it easier on the people involved. You may also learn to value your own life more. That being said, another way to acknowledge feelings is to hit them head on and say to yourself or your nurse friends, “This is sad,” “This is unfair,” “Life is unfair,” or “I am sad.” Verbalizing it always makes me feel better.

Through trial and error you will find ways to cope with our very real-life job. However, I can’t actually tell you that it is okay to show your emotions at all costs because of the aforementioned reasons. Also, if you can’t control your emotions, you won’t be able to focus on the task at hand, whatever it may be.

Expensive scrubs are not necessary

I bought my tightest and most expensive scrubs right out of nursing school. As time progresses, my scrubs get baggier and cheaper. It has become more about comfort and mobility for me because the job is very physical. You will be laden with more bodily fluids than imaginable. There are nights that I leave and throw my scrubs in the trash because I am so repulsed by them. I keep a couple pairs of “nice” scrubs for my non-hospital job, but in the ICU, baggy scrubs win every time.  Oh, and if you think you look better in the tight scrubs, I guarantee we will all love you either way.

Nurses are people, doctors are people, people are people

One of my biggest lessons in nursing is this: people are people. It doesn’t matter if you wear a white coat, you work for environmental services in the hospital, or you are in IT, we are all the same in so many ways. When I started in bedside nursing, I was very intimidated by the big personalities, fancy degrees, and titles, but when it came down to it, I realized I was no different.

I worked at an institution where nurses led rounds in the morning. The bedside nurse presented the patient in front of a multidisciplinary group and was given an opportunity for input. The first few times I did this, I was overwhelmed and stumbling over my words. I was embarrassed and felt inadequate. Then, a med student was given the opportunity to present as a learning experience for his first time as well. He stumbled over his words just as much as I did.

So, it hit me. We are all learning and we will all make mistakes. It is how you recover from those mistakes that matters. Recognize your worth, because we all have something unique to bring to the table. It is normal to feel overwhelmed, exhausted, emotional, and to question your path at times. But just remember, you will figure it out and it will get easier.

It’s hard, harder than you think

I never dreamed nursing would be as hard as it is. My experience comes from all university hospital ICUs, but it’s hard in different ways in every department. You will be very tired, mentally, physically, and emotionally when you first start. You might have disagreements with your significant others or your families because they won’t understand your schedule, attitude, or why you are suddenly so stressed.

For the first 6 months of my first nursing job, I had to arrive to work 15 minutes earlier to work to use the bathroom because I was so nervous before my shift. I lost close to 10lbs in my first year of nursing. However, around six months in you will likely have a turning point where you start to feel more comfortable. Another turning point will probably happen at a year. Then at two years, you will begin to feel fairly confident.

I’m not saying this to deter anyone from going into the profession. More so, I think new nurses need to know that it is okay to have all of these feelings and that they do get better. You are not alone. Eventually you will learn how to navigate the dysfunctional ship of healthcare and appreciate all of the gifts it will give you in return. Becoming a nurse was the best decision I ever made and I hope it is for you too.

And finally…

Good luck in the best career you could have ever chosen, you’ll be great.