If you’ve just graduated nursing school and are starting your first NICU job, you’re probably feeling a mix of excitement and worry. It can feel like you’re drowning in expectations, worried about learning the ins and outs of your unit’s culture, and fear having a tough time keeping up with a never-ending flow of patients.
The doubt you may feel about whether nursing is really your calling or not can creep in but I can assure you that is NORMAL and is something we all go through at different stages of our nursing career, especially when we’re just starting out.
Sometimes, the fear and trepidation of what’s to come is the worst part of any new journey! What helps me before diving into any challenging life situation is setting realistic goals and expectations for myself and for those around me. Below, I’ll list 11 things I wish I knew before I started my first job to help you prepare for the challenges ahead.
11 Things I Wish I Knew Before Starting In the NICU
1. Some people may NEVER appreciate what you do. This is something you are going to have to settle with right away. The goal is to try not to take the words and actions of others around you to heart. The attitude and frustration isn’t necessarily about something you’ve done, but rather is something that they can’t control when dealing with stress or anxiety.
It’s disheartening for all of us when we’re caring for an ungrateful or rude patient, co-worker, or family member. What’s important is that we keep their poor attitude from changing the way we provide compassionate and empathetic care. No matter what, it’s our responsibility to remain respectful to your patients, their family members & colleagues, even when you feel wrongfully questioned or disregarded.
It can be a tough pill to swallow to remember that in healthcare, respect is earned, not given. It may take some time to establish this with your colleagues and families when you’re first starting out. If you have a friend or family member that isn’t supporting you in your new role, bring up your concerns and try to have a healthy discussion about it. Advocate for yourself when you can and let go of the rest. Don't let this over-come you — it’s something we all continue to deal with, even after years of being a nurse. We’re all in this together! XO
2. Burnout and work fatigue. It’s not as simple as “self-care”. We all face nursing burnout and work fatigue, 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, especially when you’re working several days in a row. Not only is our work physically taxing, but it’s also emotionally and mentally exhausting as we do our part to help patients through positive and negative outcomes.
Preventing job burnout starts by leaving work at the hospital and living “off the clock” on days off. If you notice burnout creeping in, try to make some changes to your schedule. Try taking on a new role in your unit, look into career development opportunities, attend a conference, network, conduct clinical research, apply for a new job, or even consider going back to school to get your advanced degree. Nursing is far too vast an industry for you to live your life in a career rut. Don't sink into it — instead, get ahead of it.
3. You may love your job or specialty at first, but could then grow to dislike or outgrow it. Yep, this happens all the time. It may feel frustrating to put your heart and soul into a job and then decide it’s time for something new. 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 to grow to dislike it as time goes on.
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. 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 a new clinical team might help you determine where you feel most drawn to in the long-term.
4. You will work with some very difficult personalities. All types of people work in healthcare. We all have different cultural backgrounds, aspirations, and motivations to succeed. It’s important to remember that not everyone thinks and behaves like you do. This is not always a negative. In fact, I think working with people who are different from you 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. Maybe you and a team member just don't jive, which is okay too! Give yourself enough time to get to know each of your coworkers before judging them. Try to find ways to work together instead of trying to find ways to avoid them.
5. Work culture can affect you professionally AND personally. Work culture plays a HUGE factor in nurse job satisfaction. It’s something we should all ask about during job interviews. Every workplace will have a different culture. Having insight into what makes your unit tick can help you get started on the right foot and adapt if you need to.
For example, if you have always preferred to work alone and problem solve independently, a culture that embraces community discussion, bouncing ideas off one another, and problem-solving might feel intimidating to you at first. Instead of trying to fight the system, attempt to change and grow personally and professionally! If there’s something about your unit that you find toxic or negative, try to incite the positive change you wish to see.
6. Rome wasn’t built in a day (or even a year)! Getting experience and developing as a professional takes time. Being ambitious can make you a strong clinician, but don’t get hung up on wanting to be a master right 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 the initiative when you want to develop your portfolio. 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 many years and still seek out leadership and professional growth opportunities everywhere I can.
Try to seek out conferences to attend or certificates to earn that could help you solidify and expand upon your nursing knowledge! On a smaller scale, sign up for a class you’re interested in or eat lunch with a group of experienced nurses to learn how they think about certain things! Every small effort can make a big difference when you add up hundreds of small efforts!
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. Research shows that unchecked mental fatigue results in concentration difficulties, irritability, stress, depression, frustration, forgetfulness, and chronic disease. If you can’t focus on important tasks, mistakes are bound to happen, which puts your babies and your nursing license at risk. These issues also spill over into your relationships with family, friends, and co-workers.
I wish someone had told me earlier that it is not only okay to go to therapy but therapy is actually extremely helpful when processing the difficult moments we experience as a healthcare provider. The struggles, disappointments, and fears that come with being a nurse can add up and get really overwhelming. Going to therapy, meditating, exercising, and making fun plans with family & friends are all ways that I put my well-being first. I always try to be the best version of myself and bring good positive energy with me to my shifts.
You might know that you’re having a tough time but may not know what to do about it. If you’re struggling with mental fatigue but aren’t sure where to start, I recommend checking out my “10 Tips for Preventing Mental Fatigue” episode on The Cellfie Show!
8. At some point, you’ll hit a professional plateau. When this happens, SHIFT. Think about what’s next and how you can challenge yourself in a new and exciting way. We all hit a wall at different points in our careers. For some of us, it happens within a few months of starting our first job. For others it can be years before we start to feel stuck or bored.
What’s important to remember is that you’re never stuck as a nurse! Most of us chose this career path because we knew it opened so many doors and opportunities. There are so many options for you to make big moves and changes in your career, whether that includes becoming a travel nurse, changing the unit you work in, switching hospitals or even taking your career to the next level by going back to nursing school and getting an advanced degree.
One of the best parts about nursing is the flexibility it offers. If you decide that bedside isn’t for you anymore, there are other nurse roles to look into. Check out my blog “51 Nurse Jobs to Consider” for some inspiration!
9. Doctors make mistakes too We are all human and make mistakes. There will be high-pressure situations that will require immediate decisions by everyone on the medical team. However, it’s important to remember not to blindly follow orders under pressure, especially those that you question or feel uneasy about.
Don’t be afraid to speak up when you think there might be a mistake. Listen to your gut and trust your teaching. Question the appropriateness of orders, especially if you find yourself working in a teaching hospital with medical students, residents, fellows, and interns.
It can be so easy to get caught up in the emotions of an emergency situation and blindly follow a process, but you have to be strong and speak up to help your team and your patients. Mistakes can mean the difference between life and death in the NICU, so we all have to play our part to make sure we’re keeping our patients safe.
10. You will face many ethical dilemmas along the way. During your career as a NICU nurse, you’ll have moments where you disagree with how your medical team is handling a particular situation. If you feel strongly about how to handle the situation and everyone else seems to have made a different decision, it can become ethically and morally stressful. One of the hardest ethical dilemmas I’ve faced is knowing how much or how little information to share with a patient and their family. For example:
Do you continue care on a patient whose outcomes are poor just because a family wants you to?
Do you continue life-saving care on a patient because your facility’s legal team tells you to do so?
Do you choose to provide hope to a patient’s parents, even if the outcomes don’t look promising?
Are you aware of certain complications of a particular procedure that the family isn’t aware about?
These scenarios are the types of ethical issues that I find most challenging as a nurse. In these situations, it can be helpful to bounce your ideas and viewpoints off of others in your team’s chain of command. This could be your unit’s charge nurse, manager, CNS, or even the director of nursing. Hospitals also staff ethical committees to help in these challenging situations, so don’t be afraid to collaborate with them if you’re feeling particularly stressed or concerned.
11. You are the coordinator of the party When you’re new, you may have serious imposter syndrome. However, you have to remember — many family members think of you as the boss! I like to think of myself as the host of the patient’s party. As the nurse you’re the direct link between the patient and their family members, MDs, NNPs, surgeons, consultants, RTs, therapists, social workers, and radiologists. while they are under your care.
It’s important to remember that you are your patient’s best advocate and that it’s your job to ensure that your patient is given all medical information, education and treatment options so that they can have the autonomy to make the decision that’s best for them.
Obviously, this looks different depending on your specialty/unit, but the idea is the same. You are the one who is coordinating the other members of your team to keep all of the balls in the air. It’s vital that you give correct and timely information to the patient’s “team” to ensure they receive the quality care they deserve.
Okay — this sounds like a lot to handle. What’s the real tea?
Chances are, you’ll form a love-hate relationship with your nursing career. You’ll have hard days that leave you in tears on your commute home, but you’ll also have the days where you leave work feeling proud of yourself for helping to save a life.
On your hardest days, don’t forget the good days that have shaped you into the strong nurse, colleague, and community member you are today. The talent and expertise that you bring to the table is needed in nursing today more than ever before.
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Leave any questions you have about starting your new nursing career in the comments below! XO
Tori Meskin MSN 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 info@tipsfromtori.com