Starting a career in nursing can be both exhilarating and challenging. As a new graduate nurse, you’re stepping into an environment that demands constant learning, quick adaptation, and profound empathy. Discussed below are six strategies for new critical care nurses to help you with the transition to working full-time hours as a critical care nurse.
1 – Navigating the Early Challenges and Embracing Self-Care
One of the most significant challenges new graduate nurses face is adapting to a schedule that incorporates rotating shifts. Constant flipping between night and day shifts harms your circadian rhythm and leaves you feeling exhausted and fatigued. Check out the nightshift survival tips blog post and podcast episode for a comprehensive science-based guide to navigating working night shifts. A quick summary of a few of the takeaways from the nightshift survival tips episode includes keeping the temperature of your bedroom <68 F, utilizing white noise or earplugs, wearing sunglasses on the way home from your nightshift & carefully timing your caffeine intake for maximum efficacy. When you are on orientation, you typically do not have control over your work schedule. After the orientation period, play around with your schedule to see what feels best on your body with the shift requirements of your individual job. Some people prefer stacking their shifts back to back to have longer stretches of time *away* from the hospital, and other people find it best to spread their shifts out throughout the week. Try both methods for a schedule period and choose to actively reflect on which schedule works best for you.
Balancing the demands of working in healthcare requires solid time management skills. A few tools we recommend for life organization are Google Calendar for all events, Trello for your personal to-do lists, and Nurse Grid to track your work shifts. Here is a video of Anna explaining how she manages her time in CRNA school, including a tutorial on how to use Trello. Management of the time when you are not in the hospital is equally – if not more important. We recommend scheduling an event of some type in the morning of your first shift off of work. Whether that event is a workout class (Chrissy and Anna like using Classpass – try a week free) to try a variety of different styles of workout classes), or coffee with a friend, we recommend having something on the calendar ~10-11 am on your first shift off after a stretch that gives you structure to get out of the house and get your day started. Nurses spend so much time and energy caring for everyone around them, it truly is important to prioritize and schedule time out of your busy calendars to take care of YOU.
2 – The Reality of the Learning Curve
One of the most significant challenges for new graduate nurses is the steep learning curve associated with transitioning from nursing school to the bedside. Nursing school teaches you how to pass the NCLEX and provides foundational knowledge, but nursing school does not fully prepare you to be a nurse. For guidance & study tips for the NGN NCLEX check out this podcast episode https://www.youtube.com/watch?v=olhxPhyGTSg
If you start out in a critical care specialty, the learning curve is even more drastic. Acclimating to a full time bedside role is overwhelming for everyone who makes the transition, and after the peak of the pandemic, many hospitals have decreased the length of orientation for new nurses as they attempt to drive up profits.
If you are not fortunate enough to work in an area with lots of unions, you likely will not receive the support you need to thrive as a new graduate nurse.
The reason states like California enjoy working benefits like guaranteed break nurses, mandatory meal & rest breaks, and laws about nurse-to-patient ratios is all thanks to the work of unions over the last 50 years.
Union payscales are also public, and we highly recommend familiarizing yourself with what you should be paid for the lifesaving work you do as a nurse. Here is a link to the current union payscales of the University of California system https://qa.ucnet.universityofcalifornia.edu/labor/bargaining-units/nx/docs/nx_appendix-a_wage-tables.pdf
Whether you work in a union-dense area now, or you will form a union with your coworkers in the future, we highly recommend listening to the book A Collective Bargain. It should be required reading in every nursing school.
The learning curve is steep when transitioning into your first bedside nursing job.
Making a plan to address your knowledge gaps, knowing your worth as a nurse, and utilizing your resources will ease the overall stress of the transition.
3 – Embrace the Learning Process
Feeling lost or overwhelmed is unfortunately a completely normal experience when you first start working as a nurse, especially if your first job is in critical care.
We recommend viewing your first year in critical care like it is a continuation of your education. The unfortunate reality is that you cannot learn everything you need to succeed and thrive as an ICU nurse during orientation alone. You have to study outside of work on your days off if you want to build a foundation of core critical care concepts that will prepare you to be a safe ICU nurse.
When I was a new graduate CVSICU nurse, there were no comprehensive resources available to guide my ICU education. I watched countless YouTube videos, I read The ICU Book, and I studied for the CCRN using Barron’s, all according to the advice of my peers. But I didn’t feel that anything answered all of my questions, there were no educational resources that were written by ICU nurses and CRNAs for ICU nurses. This is why we built Confident Care Academy. We wanted to provide the resources to nurses that did not exist when we started our careers in critical care. Confident Care Academy is a community of >1,000 ICU nurses and future CRNAs that has wrap-around community support, and>60 lectures written from anesthesia school source texts to support you every step of the way from the ICU and ER to anesthesia school. Confident Care Academy is also CE eligible-meaning you can submit your receipt for the annual subscription to your unit educator for reimbursement with any eligible education dollars.
To succeed as a trainee in the ICU we recommend keeping a notes app or journal and writing down topics that you are not familiar with, and looking up those topics on your days off. For example, what are the weaning parameters required prior to extubation in surgical patients? What is the mechanism of action of milrinone? Why do we give calcium after multiple blood products?
We recommend investing the time to build a solid foundation as a critical care nurse and committing to working through one critical care or foundational ICU lecture a week. Starting with the Foundations of ICU Nursing bundle in the Confident Care Academy membership will teach you how to give ICU report, will walk you through assessments and the basics of hemodynamics, and will start to give you the time management tools you need to succeed.
Check out the Confident Care Academy community https://www.confidentcareacademy.com/ and click here for a free ICU & time management sheet.
5 – Prioritizing Self-Care and Balance
The demands of a critical care job can easily overwhelm even the most seasoned nurse, so for new graduate critical care nurses it is even more essential to prioritize self-care and maintain a work-life balance.
What are a few measurable ways to prioritize maintaining a work-life balance?
- Ensure you are spending time with friends weekly. Be “the planner friend” if necessary, book a reservation at a fun restaurant, look up a hike in the area, it’s important to have at least “something” on the calendar every week that isn’t work.
- Start to prioritize building friendships with people outside of healthcare! It’s important to have friends who “get” what we go through day in and day out working in the hospital, but for balance, it is also key to have friends who are outside of our healthcare “bubble”.
- Prioritize neutral or kind self-talk. You are a brand new critical care nurse working in a high-stakes and high-stress environment. Speaking to yourself harshly when you don’t know something or made a mistake does not improve patient safety or make you a stronger nurse. Instead of profusely apologizing when you learn something new, thank the person who invested the time into teaching you. While it is hard for the anxious people pleasers who choose careers in critical care to do, consciously use language to describe yourself as a morally neutral person who is trying their best. One book I wish I had read as I started working in the CVSICU was “The Courage to Be Disliked”, I’d say it’s a must read for anyone who struggles with anxiety or people pleasing tendencies.
- Incorporate movement that makes you feel good. Whether this is a workout class you attend weekly, running, walking, sports, or dance classes – make sure you are taking time to take care of yourself! As someone who has moved 7 times in the last 4 years, I also like ClassPass to check out workout classes in a new area. Here’s my referral link for a free week.
6 – Finding and Cultivating Mentorship
Mentorship is crucial in helping new critical care nurses navigate the complexities of their new roles. You did not learn in nursing school how to find or maintain relationships with mentors. Here are a few broad recommendations:
- Prioritize finding a “safe person” for every shift. This safe person is someone you trust to answer your questions without judgment. You will likely have 2-4 primary preceptors throughout the course of your ICU training, however, large ICUs have a staff of >90 nurses and you want to identify your “safe people” early on. I recommend feeling out whether a nurse is a “safe person” by using language like “Can I talk through something with you?” or “I pulled up the policy here but could I ask you a question about this?”, or “Could I get a second set of eyes on my patient?” or “How would you manage this?”. How the nurse reacts to this sort of language will show you whether they are a nurse who likes to teach. After a few months on the unit, ask 1-2 of your “safe people” to be your mentors.
- For professional mentorship, it’s important to network with people who are where you want to be in a few years. This can be challenging at times because after nurses start CRNA school, they are no longer working full-time hours in the ICU. I recommend attending state-level AANA gatherings and building connections with nurse anesthetists and with nurse anesthesia residents there.
- If you had a positive professional relationship with any of your professors from undergrad, keep in touch! Send updates throughout your first year of orientation. Professors love to hear that they have made a positive difference in the lives of their students, and nurturing and maintaining a relationship with former faculty will open many doors for you in the future.
- Invest in educational resources and communities. In the discussion boards and weekly live sessions in the Confident Care Academy membership, nurses ask all of their questions and receive community support from nurses and nurse anesthesia residents throughout the country. Join us today
- Give back! Once you are in a position to open doors for those who come after you, make sure you spend time investing in the next generation of ICU nurses and nurse anesthetists.
Starting your journey as a new critical care nurse can be daunting, but with proper guidance, self-care, and a commitment to learning, you can navigate these challenges successfully. Stay curious, stay compassionate, and remember, Confident Care Academy is here to support you every step of the way.
