What I Wish I Had Known as a New Nurse

When I graduated from nursing school in 2004, I applied and interviewed for only one job. I wanted to work in pediatric oncology. In my interview, the manager asked me how I would deal with death. I replied that everyone deserves compassionate care through all stages of life, even at the end of life,  and that it should be provided by people who really care. I wanted to be able to provide that kind of compassionate care.

I got the job and started a new graduate training program that lasted 13 weeks. We learned a lot about cancer, chemotherapy, managing side effects, and the psychosocial aspects of cancer care. But even from the beginning, some conversations and lessons were lacking or absent.

I remember getting a letter mailed to me at home from my preceptor introducing herself to me. It was a thoughtful way to be welcomed onto the unit. I learned a lot from my preceptor, who was very experienced. But there were a few things I learned over the years that I wish would have been included in my new grad orientation program.

Making a Mistake Does Not Make You a Bad Nurse

Everyone makes mistakes. Everyone. Let’s say that again. EVERYONE MAKES MISTAKES. Even the perfect nurse on your unit. Obviously, none of us want to and none of want our mistakes to harm patients. But the ways in which a hospital achieves that is to create and design systems that prevent mistakes. Every time we introduce something new into a system, there’s a chance for mistakes. New drug? People could make mistakes when they are still learning it. New equipment? People might program it wrong, clean it wrong, etc. But also, new people. New nurses, new doctors, a new chance for miscommunication.

I remember making my first mistake on the night shift. It was with medication. We used to store all of the similar types of syringes in the same pyxis drawer. Even if they were different doses and had different patient names on them. So when my patient was upset and wanted medication in a hurry, I grabbed the wrong syringe. Luckily, I was the right dose. This was before barcode administration. But I felt like a bad nurse. I failed the basic rights of med administration.

But I wasn’t a BAD nurse. I was a human nurse. I was dealing with my emotions, a panicky kid, another nurse telling me to hurry, and a poorly designed system.

Perfectionism is Not Necessarily a Good Thing

Maladaptive Perfectionism is a term to describe the perfectionism that has been observed in nurses from internal or external pressures. Following along with the idea that making a mistake makes you a bad nurse, is this idea that is often pushed in nursing school and throughout the profession. Some of it is internal and some of it is external messaging.

When I joined my first nursing council, we had a portion of the meeting here we examined errors, without knowing who made the error and discussed the next course of action. We were supposed to be operating under a just culture frame work. But despite that, there were always inevitable conversations that nurses would have where they said how could they do that and I would never…As a recovering perfectionist, I was right there with them, reinforcing the same ideas that we needed to be perfect 100% of the time and internalizing the message. But the outcome of that messaging was only a creeping doubt that I was not a good nurse because I was not perfect. We needed to hear the message that we were not perfect and could not expect to be, which was why we needed better systems.

Compassion Fatigue is Inevitable

In nursing school, my classmates voted me the Most Compassionate Nurse. I am sure it was based on an occasion in our first semester where a classmates patient yelled at me and I ended up eating my lunch with them and talking about their frustrations. I was a highly idealistic, compassionate new nurse committed to making a difference. What I didn’t know at the time, was that the research shows is that I was at high risk for burnout and fatigue. I also had my own life experiences, that included past unresolved trauma, that made me at risk for poor coping. How many of us go into nursing to make a difference because of past experiences? Have we fully come to terms with those experiences?

New nurses under thirty who are highly idealistic are at higher risk for dealing with the burnout spectrum. I wish I would have known that what I loved about nursing, the compassion satisfaction I get from caring for others, had a cost. That all of the kids I would care for with cancer who would not survive would take a toll. And I wish I would have been taught strategies to manage and deal with it.

A lot of what we do to prepare nurses is about the science and art of caring for others. But not enough of it is about the science and art of caring for ourselves in order to sustain the care we provide for others. What are some things you wish you would have known as a new nurse in order to sustain your career as a caregiver? Leave a comment below!

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