1. Agostino, Patricia RN, CEN, CCRN

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Whether you are new to nursing or new to a nursing unit, here are five things I believe are important for you to know based on over 45 years in the profession.


1. Never be afraid to say, "I don't know."

Never be afraid to say, "I don't know this drug," "I don't know how to do this procedure," or "I don't know if this lab value means I should be concerned about my patient." Performing tasks regardless of not knowing how to do them could risk your patients' safety.


Why does this happen? Frequently, it is due to the fear of being perceived as incompetent or embarrassed in front of colleagues. These fears should be alleviated once you know that hospitals are aware of the "transition shock" that new graduate RNs face as they leave educational institutions with little clinical experience.1 Hospitals put enormous effort into developing quality onboarding programs. They offer mentors and preceptors to guide you one-on-one for months, sometimes up to a year.1 These programs ensure you become a competent nurse and keep patients, as well as yourself, safe. You must do your part by being engaged and motivated to use all available resources, including clinical educators, clinical educational programs, and hands-on clinical workshops.


Throughout my career, I have worked in med-surg, ED, ICU, OR, endoscopy, and as an educator. When someone asked me how I could work in all of those areas, I replied that it was because I was never afraid to say, "I don't know." Was I embarrassed at times? Yes! But I was more interested in providing safe and competent care to my patients than I was in my ego or pride. This attitude has allowed me to keep exploring the profession I continue to love.


2. On the other hand, don't be afraid to say, "I know."

Knowledge is to be shared. It does not matter that you are a novice nurse. If you know something that could be helpful, speak up in the patient's interest, but realize that your delivery is as important as the message. Preface your advice with words like "I believe," "perhaps," or "what if" to communicate your thoughts helpfully and confidently.2


Read the scenarios below, and determine the best response. Assume that the patient may be listening to your conversation.


You are helping a colleague with a routine finger-stick blood glucose level in a patient without diabetes, and you both note the blood glucose is registering 480. Your colleague says they are going to get an order for insulin. Your reply:


a. "Do you think that we should first confirm the result by retesting? Then, if it is still elevated, we can alert the provider so that they can order more testing and treatment."


b. "You can't give insulin with that number! The patient doesn't even have known diabetes, and you don't even know why it's so high or if that's the correct reading. Besides, I see he's on steroids-you didn't even ask about meds!"



You see a colleague enter a dosage into the infusion pump for I.V. fluids at 1,000 mL/h when you know the order is 100 mL/h. You say:


a. "Hey, you set the pump for 1000 mL's an hour instead of 100 mL's an hour, and the patient has a history of heart failure! Don't you know you could kill them with that much fluid?"


b. "Let's look at this rate setting. The patient has a history of heart failure, so let's hold off starting the pump until we clarify this."



Offering advice in a humble, courteous, and safe manner greatly affects the response one receives. It is also vitally important to never hesitate to intervene if you witness a serious error about to be made. Witnessing without intervening makes you equally liable for the error and for causing the patient harm.


3. Be a team player

Nursing is a team sport. None of us work in isolation; we are part of a huge interdisciplinary team and all work together for the patient's good. One small but memorable way to be a team player within your unit is to observe if a colleague appears pressured, stressed, or overwhelmed. Approach them and say something like, "I'm free for 15 minutes. Is there anything I can do to give you a hand?" Offer to help staff who need assistance, even staff you do not know well! The adage "one hand washes the other" holds true.


Your chances of getting help when you need it are more likely when you act as part of the team. Once you have experienced being overwhelmed, this statement will make more sense to you. Of course, be mindful of your boundaries. If your help is not accepted, do not take it personally or let it stop you from offering staff assistance in the future. Just remember that all patients benefit when we work as a team.


4. Avoid gossip

Gossiping is a form of bullying, hurting someone's character or personal attributes. Furthermore, gossiping betrays trust and confidence and tears down relationships.3 Do not repeat what you may overhear or what a colleague may share with you in confidence. It is imperative not to indulge in it, be part of it, or promote it.


Someone's opinion is not necessarily fact. A colleague once told me that a new nursing recruit in our unit was unintelligent because she was unimpressed with her work history, assumed she had limited knowledge of patient assessment, and stated the new nurse should never have been hired by any hospital in any position. I thought that was a premature and rather vicious assessment. But unfortunately, she made her opinion known throughout the unit. Many accepted her opinion because she was known as a very accomplished nurse.


However, I decided to make an independent assessment and conclusion. As I worked with the new nurse, I found her to be honest about her lack of patient assessment skills and noted that she had a burning desire to learn. She asked questions; went to every hands-on workshop and simulation class she could find; read books on patient assessment; worked closely with the clinical educator, preceptor, and mentor; and asked willing staff to teach her. She learned quickly, eventually becoming certified in our specialty, and, as a strong patient advocate, became an asset to our team.


Over time, you will formulate your own opinion of your colleagues. Please, do not rely on gossip.


5. Determine if the work and unit are a good fit

Do you feel excited by what you are doing and learning? If so, show your desire to learn and passion for the work. How? Subscribe to and read journals that expand your knowledge. Go to conferences focused on your area of practice. Volunteer to join committees or projects undertaken by your unit. Actively listen in staff meetings, ask questions, and offer ideas. Finally, ask the clinical educator for recommendations for expanding your knowledge and competence, perhaps by becoming active in a nurse's professional organization. Eventually, consider becoming certified in your area of practice.


Are you unhappy with your job? What may be your part in that dissatisfaction? Were your expectations unrealistic? Did you always imagine yourself as an ED nurse but find that going from calm to a crisis in a nanosecond is not your cup of tea? Do you dislike or not respect the manager or find management difficult to deal with? Remember, even if you feel negative about the manager, you must respect the position. That means not acting or speaking disrespectfully, regardless of your personal feelings.


Do you feel you will never fit in the unit? All of these things take time, so give them the time they deserve. If, after careful thought, you decide you want to transfer or leave the job, still try to learn all you can while you are there. Knowledge is never wasted and is always a resume builder.


Nursing consists of many jobs in one, and each comes with abundant opportunities. Don't feel locked in place. Feel free to explore the varied world of nursing until you find your passion and your place in it. To quote Dr. Seuss, "Oh the places you'll go!"4




1. Murray M, Sundin D, Cope V. New graduate nurses' understanding and attitudes about patient safety upon transition to practice. J Clin Nurs. 2019;28(13-14):2543-2552. doi:10.1111/jocn.14839. [Context Link]


2. Morin DA. How to stop being a know-it-all (even if you know a lot). SocialSelf. 2021. [Context Link]


3. Healthy Workforce Institute. Surprising insights about gossip in the workplace and how to stop it. 2017. [Context Link]


4. Dr. Seuss. Oh, the Places You'll Go! HarperCollins Children's Books; 2016. [Context Link]