Congratulations on passing your NCLEX and landing your first job! You’re probably feeling a mix of nervousness and excitement — don’t worry! We’ve all been there. A lot of what you’ll need to know about patient safety you learned in nursing school. However, most of the practical skills you’ll need will be taught during your first few weeks on the job.
Looking to make your transition to practice a positive learning experience? I’ve collaborated with colleagues, professors, and nursing school friends to come up with this list of tips to help your new grad career get started on the right foot.
1. Never be afraid to ask questions.
Asking questions as a new grad nurse can be intimidating. For the safety of your patients, ALWAYS ASK if you’re unsure of how to do something or why your patient needs a particular medication or test. You’d be surprised how many seasoned nurses may have the same question — you can help your coworkers learn too!
2. Admit when you’ve made a mistake.
In the healthcare world, mistakes happen every day. When you’re just starting out, don’t make a habit of covering up a mistake, blaming others, or trying to argue your way out of it. Your colleagues will understand if you admit to your mistake and ask for help in reducing the consequences of your error.
3. Don’t hesitate to take a few minutes for yourself.
If you need to use the restroom, ask a coworker to cover for you. If you need to hydrate, drink before continuing with your tasks. Most nurses delay the little things they need because they’re in a rush to finish a task but in reality, if you are too hard on yourself the work you do will be affected.
4. Always perform routine safety checks after receiving handover report.
Before diving into shift tasks, it’s always important to make sure you have the necessary equipment at the bedside in case of an emergency. You’ll want to verify that you have items like a suction catheter, ambu bag, code sheet, functioning oxygen canister and tubing, IV initiation set, alcohol/chlorhexidine wipes, saline flushes, and gloves.
5. Know the SIZES of all tubes & lines in your patient.
In the NICU, our patients are tiny and delicate. You’ll want to make sure you know what size lines and tubes your patient has. As part of this assessment, you’ll also want to know how deep these tubes are and keep track of those measurement numbers as well. Important lines and tubes include NG/OG tubes, IVs, ETTs, UVCs/UACs, PICCs, chest tubes, Foley catheters, etc.
6. Keep up with your charting.
If you save your documentation for later, you might be rushing to finish before your shift ends. You can’t fully anticipate when you will be really busy, so stay up-to-date on your charting as often as you can. It’s also important for the multidisciplinary team to be able to review your charting and trend the data, so you’ll want the most recent assessment and vital signs readings to be updated in the chart as soon as possible.
7. Don’t be too hard on yourself.
You’ll learn hundreds of new things each shift. What’s important is that your coworkers and managers won’t expect you to remember everything or perfect every skill after your first try. Having patience with yourself will help others have patience with you as well. Take your time, you’ve got a long career ahead to master your skills!
8. Before calling a doctor, always think about & make a list of the things you need to mention.
You can’t fully trust your memory when talking through a phone call especially when the doctor is always in a hurry. I like to make little notes of the things I need prior to calling or paging the doctor so I don’t forget any important details. For example, if you call and ask to increase a vasopressor dose, make sure you have a set of recent vitals to share with the doctor. They’ll want this information as well!
9. Invest in comfortable footwear.
You will take thousands of steps every nursing shift, so wear appropriate nursing shoes that are made for comfort and durability. I also recommend getting a pair of shoes that can be easily washed or wiped. Check out my favorite brand, Sanita Clogs, here! PS: You can use the code “Nurse Tori” for 20% off your order.
10. Learn to be assertive.
Building confidence takes time. Watch and learn from seasoned nurses how they give report, ask questions, take phone calls, and communicate with family members. While these skills are practiced throughout your career, it’s important to start practicing while you’re just starting out.
11. Avoid being involved in workplace gossip.
We’ve all witnessed this sort of catty behavior in school, in clubs, or in the community. Being known as one of the unit’s gossip queens will do nothing good for your career as a nurse. Instead, try to get a reputation for being kind, helpful, and intelligent.
12. Always research new medications before you give them.
You may have never heard of some of the medications that you’ll be administering in the NICU. Before giving them to your patient, take the time to understand why you’re giving the medication, potential side effects, IV compatibility, and the appropriate dosing range. If you’ve researched and still don’t know why or how to give the medication, ask a coworker for advice.
13. Read the doctor's notes.
Nursing report can get busy, and you don’t always have time to relay every single part of a patient’s history. Make a habit of reading through the doctor’s notes and plan of care after receiving report. These notes are comprehensive and could help you find extra details or information that you weren’t aware of.
14. Make your statement short and precise when calling a doctor in the middle of the night.
When calling a doctor, you’ll want to have a short and sweet request. You might think that providing a long detailed story or explanation could help, but it usually makes your request more confusing and complicated. Get straight to the point and ask for what you need. Doctors will respect this and thank you for it!
15. Extend a helping hand to your colleagues when they need it.
You will soon realize how helpful it is to have caring co-workers. The more often you show that you’re willing to help your neighbor, the more likely it is that they’ll help you the next time you need it!
16. When in DOUBT, take the line OUT!
NICU IV’s only usually last 24-96 hours depending on the baby’s size and vasculature. If their IV site looks puffy, red, swollen, is difficult to flush, or blanches, take it out!
17. Don’t fully trust an IV pump or other piece of equipment.
Make sure to manually check the rate, volume, and concentration of the IV fluid you’re infusing during rounds and before starting a new drip. This will keep your patients safe and will also help you understand how much fluid volume is going into your patient every hour.
18. When calculating the volume for new medications or narcotics, always ask an experienced RN to double check your work.
This will give you confidence and security that you have drawn up the medication the right way. If you’re not sure how to prepare the medication, ask how they would reconstitute and administer it. You’ll notice a trend here — ask all of the questions!!
19. Be careful with your charting.
Remember that in the medical world, if it is not charted, it was never done. Your charting will be significant if a lawsuit is brought against you or the hospital. This is important to consider when having conversations with doctors and family members as well. If you relay an important assessment finding or vital sign, chart who you told and when you had the conversation. This might seem unnecessary, but trust me, you’ll always want to cover yourself, especially during critical moments.
20. When you are about to do a procedure like dressing change or Foley catheter insertion, make a list of all of the supplies you’ll need so you don’t forget anything.
If you’re placing a new IV, have a couple sets open and ready. Even if you’re only changing a baby's diaper, make sure to have everything you need at the bedside before opening the isolette. This will save you time if something unexpected happens during the procedure.
21. Always get the right size of gloves for your hands.
Gloves work better when they fit your hands perfectly. Don’t rush and grab a size that’s too large or small, especially during a crisis situation. You’ll want to make sure your dexterity is as good as it can be. This starts with wearing the proper size of gloves!
22. Show the world what professional nurses look and act like.
Just remember that wherever you go, you are representing the nursing profession. Especially when you’re in your work scrubs, your actions, appearance, and attitude should reflect the nursing profession you have worked hard to enter.
23. Always try to appear calm and relaxed, even if you’re freaking out on the inside.
If you appear calm and coordinated, it’s more likely that your patient and their family members will read your calm energy and relax a bit. This skill can be especially helpful during emergency situations.
24. Treat yourself at the end of a tiring shift.
12-hour shifts can be long and exhausting, especially when you work more than one in a row! When your shift ends, always remember to #TREATyoSELF! This could mean getting yourself a nice dinner on the drive home from work, or it could mean enjoying a cup of herbal tea before heading to bed. This will give you the energy and motivation you’ll need to continue through the challenges during your next shift.
25. Wear compression stockings.
Nursing involves a lot of time on your feet. Take care of your legs early on in your career so you can avoid developing varicose veins down the line. There are tons of cute nurse compression socks out there to make you feel less like a granny — check them out here!
26. Be open to advice.
If a preceptor or other senior nurse recommends an easier way to do a task, try it. Experience is the best teacher and your senior nurses know what they’re doing!
27. Take advantage of the time you have with your preceptor. When you are working under a preceptor, ask for suggestions and tips! Your hospital is paying you to learn, so this is the perfect time to ask ANYTHING you’re unsure about. You are new and your coworkers know that.
28. Organize your shift and make a tentative schedule for the things you need to do.
I recommend making a tentative hourly schedule on the back of your nursing report sheet to organize your shift. Prioritize which needs to be done first and make sure those tasks get completed before things get busy.
29. Get to know everyone in your unit.
You’ll want to become familiar with all of the employees who work on your unit. This includes the respiratory therapists, doctors, techs, secretaries, and janitors — not JUST the nurses. You don’t need to become best friends with everyone, but getting to know them will help you adjust to your new unit and feel more comfortable asking for help.
30. Relax — things do get easier!
All NICU nurses who are new in the profession undergo the same period of adjustment, so be patient. Being nervous is a good thing at first, but everything will get more comfortable with time :)
31. Avoid complaining.
Complaining at work affects the mood of your co-workers. Try to stay positive and minimize negativity. If you have a legitimate concern or issue with the way something on your unit is done, bring it up to your manager or supervisor instead of ruminating about it.
32. Delegate tasks.
Some nurses think they can get everything done themselves. In the NICU, it’s impossible to do all the work alone. Delegate simple tasks to others in a respectful manner and reach out for assistance if you’ve got a busy shift and need a hand.
33. Develop your own support system.
It can be helpful to talk about your problems at work with someone who understands the challenges and stresses of nursing. A mentor can help you work through difficult days and keep your spirit alive.
34. Set goals.
What do you want your career to look like in 5 years? Setting nursing goals will help you maximize what you achieve as a nurse. These could include objectives like becoming certified, going back to school, or becoming a charge nurse on your unit.
35. Find a hobby to enjoy on days off.
Joining a club or hobby can help direct your attention away from your job while you’re at home. It’s easy to worry about patients or think of your coworkers when you should be relaxing and recovering from your shifts.
36. Take the opportunity to watch procedures while you’re on orientation.
Seasoned nurses have their own tricks for doing procedures like Foley catheter insertion, dressing changes, sterile line changes, and admitting a patient. Offering a second pair of hands will show that you’re not only looking to help your team, but that you’re also looking to take the initiative to learn from the best.
37. Be flexible.
If you are asked to float in another unit for extra help, accept it. If your unit has a difficult assignment that you’d like to learn from, offer to care for the patient. You’ll learn a lot by taking on challenges and being flexible.
38. After experiencing a tough shift, you’ll have nothing to fear.
If you run three codes in a single shift, the next time you have a code you will know what to do and won’t have the same level of fear you had the first time you handled an emergency. The same thing applies when inserting IV lines, helping with a high-risk delivery, and admitting a patient After doing an IV insertion hundreds of times, you’ll find venipuncture easy.
39. When receiving verbal orders, right down what you hear and read the order back to clarify.
There’s an old saying that we forget 80% of what we hear within a few seconds of hearing it. When having a discussion with a doctor, take notes so you can feel confident knowing you're taking the right action. This can keep patients safe and also protect your license.
40. Don’t dwell on mistakes.
Like mentioned earlier, making mistakes happens to everyone, even in high risk settings like the NICU. What’s important in these situations is that you learn from your mistakes and move on.
41. Don’t apologize for doing your job.
If you need to call the attending physician in the middle of the night, do it without hesitation. If you need to assess the baby while the mother is holding their child, don’t be afraid to tell her what needs to be done. It can be awkward and uncomfortable, but you’re just doing your job to protect your patient.
42. No matter how tired or stressed out you are, always approach your patients with positivity and a gentle touch.
Patients are in the NICU because they have illnesses. While they can’t thank you for your attention and devotion, they have a future because of you. If you’re having a tough personal day or can’t bring your best to work, consider taking a sick or mental health day. This is celebrated these days, not looked down upon. This can help you show up with your best foot forward every day.
43. Get a NICU reference guide to use on your first few months of the job.
In nursing school, you’re tested on your ability to remember medications and side effects. Now, you’re allowed to use “cheat sheets”. Don’t be ashamed to carry a bedside nursing reference book or drug guide during your first shifts.
44. When you’re faced with a crisis and you don’t know what to do, always start with the basics.
If you’re faced with an emergency situation but aren’t sure where to start, begin with what you know. Collect the patient’s vital signs, perform a head-to-toe assessment, visualize your lines, tubes, and support the baby’s breathing if necessary. The other important assessments will stem out from here.
45. Listen to your “gut feeling”.
Trust your instincts. As you develop skills and an understanding of infant anatomy and physiology, you’ll develop gut feelings that will help you along the way. If something doesn’t feel right, it probably isn’t. If you feel uncomfortable about something and want to ask a doctor about what to do, your discomfort is what will save your patient.
46. Leave your work stress at the hospital.
Go home with peace in your mind. It is unfair to think about what you might have forgotten to do at work when you are already at home with your family. The great thing about nursing is that there’s always someone at the hospital handling the patient workload. While you’re off, enjoy being off. It’ll be your turn to go back soon enough, so enjoy the peace!
47. If a seasoned nurse grills you when you’re giving report, don’t take it personally.
Some nurses may come across as demanding and rude when getting report. While this may seem personal, they’re there for the same reason as you are: to care for patients and get babies home to their families. Those that have worked in the NICU for years probably know more than you do, so take every opportunity to learn from them and thank them for their tips and support. Soon enough you’ll be the seasoned nurse giving pointers :)
48. When giving medications, double check your six rights.
When administering a medication, even if you’ve given it one hundred times, you’ll want to review the six rights of medication administration – right medication, right patient, right time, right dose, right route, and right documentation.
- NICU Common Meds & Code Meds at Your Fingertips -
49. If no one seems to be taking your concerns seriously, raise them to the medical chain-of-command.
As a new grad, you may feel like doctors aren’t taking your concerns or worries seriously. If you’re not getting the attentive response you need, consider raising your concerns to the chain-of-command. Start with a resident or fellow, and go up to the neonatal nurse practitioner and neonatologist after that.
50. Do your physical assessment properly as it will serve as the foundation of your care.
Practice it over & over with a systematic approach. Soon it will become second nature with a speedy, detailed, accurate approach. When you feel comfortable performing an assessment, you’ll gain a load of confidence in recognizing changes and abnormalities.
51. Use proper body mechanics!
When pushing equipment, lifting objects, moving isolettes, and charting, protect your body. Stand with good form and avoid bending at the waist. Your future self will thank you!
52. Take (and appreciate) your breaks when you’re allowed them.
When you’re new, you might feel compelled to chart through your break or say “no” to someone covering you for a few minutes while you grab a bite to eat. Experienced nurses will tell you to TAKE YOUR BREAK! You’re entitled to at least a few minutes of rest during your 12-hour shift. Whether you use that break to rehydrate, eat, or take a nap is up to you, but be sure to use your time to find some peace in the middle of your shift.
53. Never forget the reason you became a nurse.
Think about why you became a nurse whenever you are feeling tired, run down or burned-out from work. It will help you get through the rough times of being a nurse and will keep you motivated to improve your practice and the lives of those you care for.
54. Put compassion into everything you do.
Remember, when you’re a NICU nurse, you’re caring for someone’s most precious gift. You’re caring for a neonate/preemie or infant at their most vulnerable moments. Speak softly, act with a sensitive touch, and listen with attention. Families will never forget it.
55. It’s never too early to save for retirement!
Most organizations provide employees with a retirement savings plan in their benefits package! Whether you are able to contribute 5% or 15%, start contributing money towards your retirement fund early! This always seems to be put on the back burner, however it should be one of the top things you prioritize!
Looking for more ways to get ahead?
Being a new nurse is hard, but here at NICUity, we’ve got your back! Our educational guides and resources can support you during the first few months of your career and beyond.
Tori Meskin has been a dedicated clinician since 2012, working in acute care and inpatient NICU settings in Southern California. She holds a National NICU Nurse Certification (RNC-NIC) and has extensive experience as a travel NICU nurse. Tori is a sponsored MSN student at Capella University and a Brave Beginnings Ambassador. She recently launched NICUity, a company dedicated to empowering NICU professionals with education, bedside tools, and resources. Follow her journey as she navigates the NICU world, married life, and new motherhood, all while juggling work, school, and content creation. Discover her top-notch tips and tricks at www.tipsfromtori.com or contact her at tipsfromtorimanagement@gmail.com.
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