Working as a nurse comes with a lot of responsibilities. Nurses tend to the sick and injured, educate patients, work alongside physicians, and more.

Because of these responsibilities, it can be a mentally and physically challenging role. While taking care of patients, nurses may also face anxiety, rising nurse-to-patient ratios, and feelings of burnout.

Their hard work doesn’t go unnoticed, though. For 16 consecutive years, nurses have been ranked as the most trusted and honest professionals, according to a Gallup poll. The rewarding aspects of nursing can make those challenges worth it, and many nurses have learned to work around the obstacles to provide the best quality of patient care.

In this guide, we interviewed four nurses in their first few years of nursing to learn how they overcame challenges in order to survive and thrive in their careers. From these interviews, as well as answers gathered from social media platforms, you’ll hear from nurses with real-world experience on likely situations you’ll encounter in your new role.

The nurses featured in this guide include:

• Lauren G., BSN, RN
• Macy A., BSN, RN
• Sylvia B., BSN, RN
• Erin D., LPN
• Michelle Cash, King University Online Assistant Professor of Nursing, RN-to-BSN coordinator, MSN

Nurse Anxiety

Being a nurse comes with a lot of responsibility, from standard bedside care to emergencies and unexpected situations. For newer nurses, thinking through all the tasks they must complete while still learning on the job can be anxiety-inducing.

I have been in my unit for over a year now, and there are some days I am still anxious to go to work. To some degree, it gets better (over time) as I learn more and become more comfortable in my skills as a nurse. – Macy A., BSN, RN

Stress and anxiety are common in nursing. A survey of workplace environments by the American Nurses Association (ANA) found that 82 percent of respondents felt they are at a “significant level of risk” for stress in the workplace. In addition, 33 percent said they had a higher workload than they felt comfortable with. The good news is the survey also reported that 67 percent of respondents had access to health and wellness programs at the worksite, meaning most nurses have resources available to them to combat stress and anxiety.

While having a significant amount of anxiety can lead to other problems, such as burnout, having a little bit of anxiety isn’t always a bad thing, and it’s fairly common.

I have seen nurses who don’t have anxiety and are over-confident in what they are doing, and that can be scary at times. We deal with people’s lives, and if we make a mistake or miss something, it can have bad consequences. To me, having a little anxiety is a normal part of nursing. – Macy A., BSN, RN

Nurse Care

A new nurse can’t stop worrying about completing all the tasks before shift changeover. How can this nurse cope?

When I start to feel anxious, I normally talk to one of my coworkers or take a break to regroup.– Erin D.

You have to know to ask for help when you need it and be able to say, ‘I messed up’ or ‘I don’t know.’ You also have to have some sort of stress outlet where you can disconnect from work and the stress and take care of yourself.– Macy A.

At the beginning of the shift, I would sit down and plan my day. I would look at everyone’s medication and when they were due, along with dressing changes, labs, and other tasks. I would write everything down in order to remember what and when I had to do things. I became very good at prioritizing and clustering my care. It definitely helped to ease my anxiety.– Lauren G.

Nurses Eat Their Young

Stress and emotions run high in a healthcare environment, so it’s not implausible that bullying behavior could take place. The phrase “Nurses Eat Their Young[KB1] ” became an informal description of some of the interactions between veteran and new nurses.

Anecdotally and in studies, there are stories of nurses experiencing bullying behavior or unhelpful coworkers in the early years of their careers. A study from 2012 found that 76 percent of the respondents had faced bullying behavior over the past month.

As a new nurse, you are going to work with new people every single day. You will come across a difficult coworker. My best advice is to keep to yourself and focus on the care of your patients. That’s truly your main focus. You don’t have time for drama on the floor; it’s chaotic enough. If the difficult coworker is a recurring situation, I would speak to your manager. – Erin D., LPN

Be open and upfront with the person, and if that does not help, go to your manager. That’s what they are there for. – Lauren G., BSN, RN

n 2018, nearly 10,000 nurses signed a pledge to provide a better work environment, championing the phrase “Nurses Support Their Young.” In addition, The ANA published a position statement, which formally opposed bullying in nursing and provided a framework for how it can be eradicated. The statement includes not tolerating workplace violence, encouraging nurses to collaborate on creating a culture of respect, and adopting evidence-based strategies to prevent bullying, such as a nurses’ bill of rights to set work environment expectations.

Nurse Care

A new nurse isn’t receiving help with a patient from a veteran nurse. What should this nurse do?

I would encourage the new graduate to ask for help. They need to know who their resources are and need to know how to ask for help. At the same time, the older nurse should recognize if a new graduate is struggling or if a new nurse is unsure of themselves and be open and willing to help.– Michelle Cash

Sometimes you have to take a step back and try to see where they are coming from. You should always feel comfortable enough to speak to your manager or leader of an area if the situation doesn’t improve.– Macy A.

Nurse-to-Patient Ratio

Whether due to an emergency or short-staffing, nurses can experience a shift where they are assigned more patients than usual. Caring for more patients can throw off nurses’ time management and make them feel like they’re behind.

I started out with having four patients, and now they are starting to give us six. It all depends on the acuity of your patients. You may have two out of the six patients who are really sick, and it will seem like all your care and time need to be given to those two patients. Really, you have to give complete care to all six. – Erin D., LPN

You need to know how to delegate. If you come to work with three LPNs and two CNAs (nursing assistants), then you’ve got to know who can do what and how the work can be divided up proportionally. – Michelle Cash

National Nurses United, a union that is comprised of more than 150,000 registered nurses across the U.S., has proposed federal nurse-to-patient ratio guidelines for just about every hospital unit. These include a 1-to-3 nurse-to-patient ratio in emergency rooms, 1-to-2 ratio in the ICU, and a 1-to-6 ratio in the well-baby nursery. However, these numbers aren’t always represented in healthcare settings throughout the U.S.

Nationally, there is a federal law that mandates hospitals participating in Medicare have “adequate” numbers of licensed nurses to provide care to patients as needed. Though, what that number is and how to maintain that staff is not elaborated. Both California and Massachusetts have passed specific nurse-to-patient ratio laws, and seven states (Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington) have laws mandating hospitals have staffing plans and committees.

Nurse Care

A new nurse learns two coworkers have called in sick. Their patients will be distributed among the nurses on the floor, increasing the number of patients each nurse will care for. What should this new nurse do to keep from being overwhelmed?

It’s a hard, busy day, but you can always ask your coworkers and charge nurses for help. I insist you do in situations like that. That’s what they’re there for, to work as a team to make sure your patients are getting quality care.– Macy A.

It’s about time management and prioritizing. You’ve got to realize and prioritize what’s the most crucial thing this moment. If you’ve got three patients calling out – one for coffee, one for chest pain, and one for the bathroom – you’ve got to prioritize what’s the most immediate need. One of the things I learned along the way, if there are five things going on at once, ask yourself, ‘if you could do one thing and go home, what would that be?’– Michelle Cash

Day vs. Night: The Advantages of Both

t’s industry standard for nurses to work 12-hour shifts broken into day and night shifts. Some of the reasons for extended shifts include fewer nurses per patient, ensured 24-hour patient care, and three-on, four-off schedules for nurses.

For nurses entering the field and those who have just started, there are plenty of advantages to working either shift.

As a new nurse, the night shift was better for me because it’s slower. You have more time to think about what you’re doing and apply your nursing school knowledge. I would write things down that I had questions about so I could look them up when I was off. Writing down questions I had helped teach me a lot. – Erin D.

On the day shift, we see more patients, so you’re super busy. But on the night shift, you have less staff and resources, so you feel busier even though you may see fewer patients. – Sylvia B.

Other benefits of working the night shift can include:

• A higher hourly wage compared to the day shift.
• Young parents can be home with their school-aged children during the day.
• With fewer visitors and doctors at the hospital, there’s more freedom on rounds and a shorter wait time on elevators between hospital floors.

A possible negative to working night shift is increased short-staffing. There are fewer staff members scheduled, which means fewer resources to assist new nurses. During the day, though, a full schedule could keep those extra staff members too busy to help.

Benefits of working the day shift can include:

• Better access to resources, including medical students or nursing assistants and an open pharmacy.
• More learning opportunities for young nurses in terms of shadowing veteran nurses or learning how to prepare patients for different exams or surgeries.
• The cafeteria is open during the day, but Cash has reported bigger hospitals sometimes open the cafeteria for an hour or two overnight as well.

Best Sleep Practices for Night Nurses

The National Sleep Foundation stated that overnight workers are at risk for “frequent sleep disturbance and associated excessive sleepiness.” Ensure you have the best sleep possible with these tips:

• Hang blackout curtains
• Wear earplugs
• Avoid spicy foods before bed
• Inform family and friends of sleeping hours]

Sleep seems to be the biggest advantage for working the day shift, as the hours don’t interfere with a traditional schedule. For most nurses on the night shift, it can be difficult to change your body’s natural circadian rhythm. To keep energy levels up, many nurses and doctors, whether they work day shift or night, swear by caffeinated drinks like coffee. A 2012 survey commissioned by Dunkin Donuts found that nurses were in the top five professions that required coffee to help get through the work day.

Top Professions That Need Coffee the Most

1. Food Preparation/Service Workers
2. Scientists
3. Sales Representatives
4. Marketing/Public Relations Professionals
5. Nurses (Nurse, Nurse Practitioner, or Physician Assistant)]

I learned to love coffee and would look forward to it every day. One cup of coffee in the morning and another cup, if I had time, around 3 p.m. or 4 p.m. was what helped me most. – Lauren G

(I advise new nurses) to drink a lot of coffee, and just get up and move. Sometimes if you sit down and stop, it makes it harder to get back up. – Macy A.

Of course, excessive caffeine can have negative consequences, such as insomnia, nervousness, and irritability. To avoid these side effects, many nurses turn to other ways to keep going late in a shift.

To keep your energy up, I suggest drinking water, eating high-protein snacks, and taking a few minutes to take a deep breath when you feel drained. Sometimes, I even do ten jumping jacks in the break room when I’m really tired. They really give me a boost of energy! – Erin D.

Nurse Care

A new nurse is placed on the night shift after working four months straight on the day shift. How can this nurse acclimate to the shift change?

Almost everyone in nursing at one point has worked night shift, so you aren’t alone. Some people love it and some people hate it, but you won’t know until you try it.– Macy A.

The day shift is very fast-paced and can be overwhelming if you’re just coming out of school. I suggest starting out on nights and moving to days when you start feeling more comfortable.– Erin D.

Nurse Burnout

Burnout is one of the biggest problems affecting the nursing field, and it can impact patient care. A study in 2017 of more than 260 RNs in hospitals across the country found that more than three in five (63 percent) said their work has caused feelings of burnout. An additional 41 percent of nurses surveyed said that they had considered changing hospitals because of burnout.

Nursing stress and burnout is a big topic on my unit because of the type of patient we care for and how sick they can be at times. – Macy A.

I think the biggest thing that happens with nurse burnout is the staffing issue. When there’s too many patients per nurse, you’re always running and never get caught up. A lot of that goes back to management and not being recognized for their work. If a nurse volunteers for an extra shift and they don’t get a thank you, they’re not going to do that again. Yes, the 12-hour shifts are long, but if the ratios are not right or it’s not staffed properly, it can be a problem. – Michelle Cash

t’s important to be able to identify some of the early signs of burnout. These include:

• Irritability
• Calling in sick
• Failing to evolve with workplace changes
• Physical, mental, or emotional exhaustion
• A feeling of “going through the motions”

Nurse Care

A new nurse is exhausted after three standard shifts plus working on-call. She’s becoming stressed and irritable. What should this nurse do to ward off the early stages of burnout?

I like to do yoga, meditate, go out in nature, or listen to a podcast. All those help with the stress after three 12-hour shifts.– Erin D.

On your days off, do things you enjoy and things that relax you, even if you need a day to just sit and watch TV. Those are days you shouldn’t think about work at all.– Lauren G.

What I Would Tell My Younger Self

n the first year of nurses’ careers, there’s a lot of on-the-job learning, adjusting to working 12-hour shifts and providing the best care they can to patients. It can get overwhelming. Here are some tips on how to survive and thrive in your first year as nurse.

You Are Your Own Best Advocate

Acting as an advocate comes in many forms, and it’s important for a new nurse to practice using all versions. Whether it’s finding a mentor and asking honest questions or standing up for the best interest of a patient, acting as an advocate can lead to an easier transition for new nurses.

Always ask for help if you need it when doing calculations, when doing patient care, or when doing something you have never done. Learn something new every day because you never know when you may use that information. – Lauren G.

Always speak up for your patient and ask questions. It is how you learn and provide better care. Everyone was new at one point. – Macy A.

One of the most crucial form of advocacy for nurses is protecting themselves in case of an accident.

Get nursing insurance and take documentation seriously. Over-documenting is better than under-documenting. – Redditer Blonder34

According to a report from the Nurses Service Organization (NSO), which provides insurance to nurses, there is an increase of nurses and hospitals being held responsible for malpractice.

In its latest survey, the NSO revealed that malpractice payouts are now more than $240,000 on average.

Confidence Comes with Time

In any job, it can take a while to become an expert at the daily tasks. Similarly, in nursing, no one expects a new employee to come in and know everything, but confidence will come over time.

Every new nurse needs to remember that it takes a solid year to feel comfortable. One day, everything will just “click,” and you will get that comfort level. – Lauren G.

Do yourself a favor and give yourself time and room to learn for a good year. Don’t let social dynamics and social politics of a nursing unit . . . get in your way of learning. – Redditer Infjenn

There are plenty of strategies nurses can use to help learn and build confidence. These include:

• Peer modeling
• Observing a veteran
• Writing questions and new techniques in a journal
• Formal skill reviews

Don’t Let Challenges Hold You Back

During an average shift, nurses face a wide-variety of challenges. These can include unruly patients, difficult families, or even workplace hazards.

Sometimes, when a patient is scared and sick, (acting out) is just how they are handling the situation. Try to be unbiased and care for them to the best of your abilities. At the same time, though, you can’t make a patient do anything. It is their right to make those decisions unless it is their intention to cause direct harm to themselves or others. Always protect yourself, and if you don’t feel safe in a situation, ask for help. – Macy A.

The first hospital I worked in had physical therapists do a training session with all the new nurses for proper body mechanics, so valuable! Ask if this is available at your workplace. If you are in a situation where you are lifting anything, clench your abs (it causes your back muscles to not clench), bend your knees, and keep the weight as close to your body as possible. – Redditer Awlovejoy

Lastly, one of the most difficult challenges a nurse faces is the passing of a patient.

Everyone deals with it differently. It’s hard when you’re in the room with the family. It’s not so much in the moment, but later on. – Sylvia B.

Overcoming these challenges provides important lessons for a young nurse, which can help give them a long and lasting career in the industry.

Self-Care is Key

When working 12-hour shifts in a high-pressure environment, taking care of yourself isn’t just a good idea: it’s a necessity.

Always try to find time for lunch, even if it’s for 15 minutes. A few minutes away from the floor and away from your patients can reset your mind. – Lauren G.

I know a lot of people who run or workout. I read, get lost in a book, in order to take my mind off work. – Macy A.

Self-care at home is especially important for those working on the night shift.

Self-Care Ideas for Nurses

Self-care looks different for every nurse, so you should try several techniques to find what works best for you. Here are some ideas for both during and after your shift to get you started.

• Grab healthy snacks to eat during breaks in the shift
• Invest in a great pair of comfortable shoes
• Unplug from social media and e-mail for an hour
• Take a nap (yes, even while at work!)
• Get a massage

Don’t Stop Learning

Evidence-based practice is the norm within the nursing industry, and there are always new updates to existing procedures. Nurses should take advantage of continuing education classes offered by their workplace setting, as well as pursuing advance degrees and certifications.

Just never stop learning. Don’t think you know it all. Learn from those around you, whether they’re RNs, nurse’s assistants, or whatever. Always keep learning. – Michelle Cash

It’s crazy to see just how much I’ve learned in the last four months, and (realize) how much I’ll learn in the next eight months. – Redditer Tasien

This sentiment is shared by many healthcare institutions, including the Institute of Medicine within the National Academies of Sciences, Engineering and Medicine. They have strongly recommended that 80 percent of registered nurses working in healthcare settings have at least their Bachelor of Science in Nursing (BSN) by 2020.

As a nurse, you should never stop learning, and you can continue your academic and nursing journey with a flexible online RN to BSN degree from King University. You can receive your degree in as little as 16 months with eligible transfer credits, and you’ll only be required to take two classes at a time. The fully online setting lets you balance your education with your busy life. Learn more about overcoming the challenges nurses face and advance your career in nursing with an online degree from King University.

Did You Know?

Earning your BSN degree comes with a significant increase in salary. According to a survey by Advance Healthcare Network, the average yearly salary for an RN with just an ADN is $75,117. For an RN with a BSN, it’s $81,323.

King University’s School of Nursing’s Professional Pillars

Integrity: The ability to walk morally upright in all actions and communications.

Commitment: The dedication and service to patients, the profession, collaboration, and continued learning while holding oneself to the highest standards of performance and accountability.

Service: Committing oneself to assist others to serve others and glorify God. Placing others’ needs before thy own. Intentional actions that demonstrate a love for others in response to our love for God.

Accountability: Making a decision based upon a knowledgeable understanding of the circumstances, acting on that decision, supporting the decision with evidence-based rationale and reason, and accepting responsibility for the outcome.

Civility: Polite, respectful, and purposefully kind verbal and non-verbal interpersonal communication and behavior.

Compassion: The feeling of deep sympathy or sorrow for another who is experiencing perceived or actual challenges or suffering, with the desire to alleviate the suffering.