So, you finished nursing school. You are (and should be) proud of yourself. You think the worst is over and in some ways, it is. You no longer have to worry about coming up with the best care plans, passing impossible tests or instructors breathing down your neck 24/7 just waiting for you to make a mistake that will end your career before you even start. How the heck can test questions have two right answers?! But, almost just as quickly as you began working your first nursing job, you can't help but think, What the hell did I get myself into.

Autonomy.

Your new found autonomy seems to be your enemy. You look back and remember how easy it was to ask that ever-nagging instructor a question right before administering a potentially lethal medication and now, there is no one there. God willing, if you get to work in a new grad program that actually supplies a preceptor, you can hopefully find them. But, even still, that takes time which you don't have and even they make it very clear that YOU are the nurse and YOU are making the decisions. That weight is heavy.

When the hell do you call the Doctor?!

Depending on where you work, calling the MD can be fairly painless. But, if you work in the majority of healthcare facilities, you call the Doc at 2 am to ask for a Colace, chances are, he/she is going to be pissed and yell at you. That one is obvious. But what about when your patient's K level comes back just slightly elevated? Or you are working on a tele floor and a patient recently had cardiac surgery and just had a 3 beat run of VTach? Do they need to know? If you call, you are the idiot new nurse because, "duh, I already know that. He was having runs of V-tach yesterday too. Only I am glad to hear they are only 3 beats now." But if you don't call and things go south... you're still an idiot. Even asking your charge nurse before calling the doctor can be intimidating. Bottom line, it just sucks. But when in doubt, it's better to be the idiot that called than the idiot that didn't.

the STRESS.

No one told me about this one and quite frankly, I think that it is the worst of all. We have all heard the statistics about how many new grads quit within the first year. I don't think it has anything to do with the actual nursing care but has everything to do with the insane amount of stress first-year nurses face. I remember praying HARD every night and every morning before I went to work that I wouldn't make any mistakes and would notice changes in my patients that needed to be addressed before they became a problem. But juggling patients with discharging, admitting, transferring, all while trying to keep them all alive by not making any mistakes (such as giving an ordered medication) puts your body through hell. I didn't know if I was coming home more mentally, or physically exhausted, only to do it all again tomorrow. People who are not nurses will never understand this and it only makes it that much harder. That's why if you are not a nurse, I highly suggest never saying something like, "you only work 3 days a week", to a nurse... unless you are suicidal. The first day off after 3, I could sleep for the full 24 hours to just recoup. The other three you spend running through every scenario and how things could have played out differently, all while trying to get all of your errands and housework done. What a break.

I'll wrap it up with this... the first year sucks. The sooner you grasp it, the easier it is to accept it. We could all sit around a table and b!tch about that fact for hours.. and I mean, hours. But the sooner you know it, the sooner you can accept and expect the suck and embrace it. Find out who your resource people are (this includes your go-to know it all and your please-come-cry-with-me-in-the-supply-room buddy) and lean on them. It is impossible to get through year one on your own and maintain your sanity. Bitch it out on blogs, sleep every chance you can get, forgive yourself, learn and improve, and remember, it will get easier. Hang in there.