Monday, May 28, 2018

New Grad Nurse Confidence: Stoking the Flame

Graduating from nursing school and becoming a new nurse is a remarkable accomplishment that can generate excitement, fear and loathing, anxiety, joy, and all manner of both positive and negative emotions.

With new nurses abandoning their nursing careers within the first 1-3 years at alarming rates, the nursing profession itself needs to wake up and smell the coffee regarding how crucial it is to support, nurture, and grow our new nurses into seasoned and confident professionals.

New grads need to pass the NCLEX, of course, and when that hurdle is accomplished, landing and starting a first nursing job is the order of the day. Where does new grad self-confidence come from, and how is it inspired and retained for the long haul?

New grad nurse
Photo by Ani Kolleshi on Unsplash

Nurse Seeds of the Future

Being a graduate nurse can be a challenge, to say the least. In nursing school, earnest nursing students learn and practice skills, interact with patients and healthcare professionals in various healthcare settings, and study the hard science and nursing theory that are part and parcel of the profession.

New grad nurse confidence can come from many places, including having the opportunity to learn and master those skills that are still in the formative stages. That first catheterization, blood transfusion, or PICC line change can be scary, and the new nurse needs the chance to practice over and over again until competence is achieved.

Learning and mastering clinical skills necessitates the guidance and teaching of seasoned nurses, and in a perfect world this can happen via a nurse grad residency program where learning, onboarding, and hands-on support are baked right into the new nurse experience.

Failing a new grad residency, a solid and well-planned preceptorship is a strong way for new nurses to learn. In this scenario, the novice is paired with a seasoned preceptor willing to be guide and teacher. I've heard both inspiring stories and nightmare scenarios where the preceptor acted as if the relationship was a true burden. Some new nurses even feel set up to fail by their preceptors, and I've spoken with several who were let go after a very negative precepting experience.

Mentoring programs can also be effective, but these should  generally come after the new nurse has gained their footing and are established in a position. Mentoring is a more long-term proposition and is very different from precepting, although this is often woefully misunderstood. Mentoring programs can also be mixed, of course, and intelligent healthcare workplaces employing nurses should examine how to bring high-quality mentoring to their facilities.

Healthcare workplaces need to recognize the value of new nurses and treat them like the essential assets they are. The succession pipeline must eventually be filled by these novices who will become the competent or expert nurses of the future, and organizations need to feed and water new nurses as if they were the seeds of the future -- which, in fact, they are.

Aside from formal support, new nurses need their rank and file peers to be kind, curious, inquisitive, helpful, supportive, and encouraging. While nurses are busy and have much to do, helping to make sure that a new grad can comfortably ramp up to full function is in everyone's interest.

Positive Messages

New nurses need to hear positive messages from both within and without their work environment. The collegial and organizational support outlined above is important, but new nurses need to receive support from friends, family, and others in their lives, as well.

Beyond friends and family, novice nurses may benefit from coaches, mentors, podcasts, blogs, journals, and other channels from which support can be gleaned. Nursing schools could do a much better job of tuning students into the plethora of information and sustenance that's out there, otherwise this information can be found by the novice nurse taking the bull by the horns and seeking it out of their own accord.

Positive messages can come from local, regional, national, and international nursing associations. New nurses would be wise to invest in seminars, conferences, CEU events, and other opportunities that afford a combination of learning, camaraderie with peers, and inspiration. To boot, the facilities and organizations that employ nurses should be sending them to such events on a regular basis in order to keep fresh ideas and information flowing throughout the workforce.

Building the Walls of Confidence

The first few years of a nurse's career can be confusing and overwhelming. The amount of knowledge needing to be transferred from the school milieu to the working world is immense, and new nurses can end up feeling like impostors.

Having said that, the only real cure for Impostor Syndrome is to keep working, learning, and gaining skill so that the demons of low confidence are starved for food. In the end, the ultimate responsibility for getting and remaining inspired is in the hands of the new nurse him- or herself. An original impulse generally leads an individual to pursue a career in nursing, thus it's up to the nurse to stoke the flame and keep the fires burning.

As much as nursing school may ignore it, personal growth remains an important aspect of a nurse's career and the marshaling of inner resources. The new nurse who ignores his or her inner world is bound to run into trouble. Ego integrity is strengthened through outer action and internal dialogue, and if the new nurse finds it challenging to maintain ego integrity, then outer resources must be pursued (e.g. counselor, psychotherapist, mentor, coach, etc). Sometimes the walls of self-confidence need building from both sides.

Stoking the Flame

Whatever fuel feeds the flames of your nursing motivation, you new nurses need to find it. If an employer provides it, wonderful. But you can't wait for your employers to step up to the plate -- most will likely strike out.

You new nurses must seek out the mentors and supporters who will buoy you in hard times, even if your problems have nothing to do with nursing. A nurse of substance sees life from all perspectives.

Feed your inner life through as many means as possible: physical exercise and personal wellness; intellectual and creative pursuits beyond nursing and healthcare; travel; friendships and community; family; volunteerism; and civic involvement. A well-rounded life will serve you well and keep nursing from dominating your every waking moment.

Stoking the flames is a lifelong process. Dedicate yourself to it and the rewards will follow. Your self-confidence and sense of personal agency are key -- make them your focus as you continue on the road. The engine of your success depends upon it.


Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

As of May of 2018, Keith is the host of Mastering Nursing, an interview-style podcast showcasing inspiring, forward-thinking nurse thought leaders and innovators. 

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the  nursing profession. Keith has written for,, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog,, American Nurse Today, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives, and his adorable and remarkably intelligent cat, George.

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