8 min read

Concerns of New Nurses: 3 Healthcare Workers Weigh In

new nurses workplace concerns

The transition from classroom learning to clinical practices is a pivotal moment for new nurses just starting out in their career. However, this journey presents both unique challenges and opportunities, shaped by the rapid evolution of technology, changing patient needs and demographics, and the lingering effects of the COVID-19 pandemic.

In fact, the Emergency Care Research Institute (ECRI)’s “Top 10 Patient Safety Concerns 2024” identifies this transition as one of their top concerns, and one that was exacerbated by the COVID-19 pandemic and subsequent workforce shortages. Two years ago, they also identified nurse staffing shortages as the most pressing concern, highlighting that this issue continues to strain the healthcare industry and new nurses who are only just embarking on their journey.

As such, it’s critical for healthcare organizations to provide sufficient preparation, training, and support for new nurses entering the field. The transition from an educational setting to hands-on practice often involves navigating the psychological toll of patient care, adjusting to shift work, and building confidence in decision-making abilities, all while striving to deliver safe and effective care.

To shed light on some of these experiences, we sought to capture firsthand insights from an interview we conducted with three new nurses, detailing their struggles, concerns, experiences, and the support that they need to thrive in the clinical setting. These responses also highlight some of the issues that need to be addressed by healthcare organizations in regard to nurse safety in the workplace, and provide insights as to what actions need to be taken at the leadership level.

How well-prepared did you feel transitioning from classroom learning to clinical practice?

“Transitioning from classroom to clinical practice was a learning experience itself. Yes, nursing school teaches you how to save a life. However, once you are actually in the moment of a critical situation needing fast acting solutions—panic! Obviously, I am not being serious, but working in a first code-blue hands on versus what my textbook told me are polar opposites. The transition was difficult but the only way to transition was to get those hands dirty!”

-Carsen, BSN, RN

“Before I began the orientation and initial training I graduated with a degree in psychology. Although classes such as abnormal psychology introduced me to some of the disorders I would see in the patient population on an inpatient behavioral health unit, this degree certainly did not prepare me for the job itself. Learning how to speak to people who are going through a variety of different mental health crises wasn’t something I learned in school, it was something I needed to practice doing as I was on the job.

One skill that I did gain from my undergraduate education that helped me at my job was active listening. This was something I learned how to do through an internship, rather than through a class. Ultimately while my classes afforded me plenty of knowledge, they did not provide me with the skills I would need to properly perform my job duties.”

-Allison, Mental Health Nurse

culture of safety webinar

How effective was your orientation and initial training at your organization? Were there any gaps that you noticed?

“I felt like my orientation to my unit was great because of my preceptor. It is so important to have someone who you get along with and is actively doing whatever they can to help you succeed. My unit required a lot of time on my own at home to learn common conditions and medications to better prepare for the acuity of patients, because it is impossible to see everything you need to know, but our educator provided the resources to do so.

We had weekly case studies to research and present on as well as online courses for critical care to help us eventually get CCRN certified. My preceptor also made sure to get me assigned to patients that would help me learn as much as possible during my 12 weeks and to see and do things that I had little experience with. I also appreciated the level of independence she provided me towards the end because once I was on my own, I didn't feel a drastic change which causes a lot of new nurses stress.

I spent the last several weeks caring for patients solo while she observed from a distance. My unit is also very team oriented, and we practice team nursing so even to this day, a year later, I have never felt like I am taking care of patients 100% on my own. I know I have senior nurses, providers, and my teammates to help me if needed.”

-Denise, BSN, RN

“My orientation and initial training were effective ... but I definitely did not ‘graduate’ from my initial orientation knowing absolutely everything I would need to know for the job. I found that I learned the most right after I finished my orientation and when I was working independently because this forced me to figure things out for myself and become more comfortable asking my coworkers questions. This seems to be the case for many of the people I work with since the classroom portion of our training was a very generalized training for multiple clinical positions.

For instance, in the classroom portion of my orientation I was learning about the machinery that was only available on medical floors. Since I work on a behavioral health unit, a lot of what was taught to me in the classroom was not applicable to my actual job, and a lot of information that would have been helpful for working in behavioral health was not included in the classroom material. After this classroom portion, I was able to shadow with a preceptor. For me specifically, I learn by doing, so despite having a great preceptor, I didn’t learn the most optimally by shadowing.”

-Allison, Mental Health Nurse

How supported do you feel when dealing with complex patient care situations?

“Being in an ICU, 95% of patients are complex and high acuity. Everyone on the unit understands this and we work as a team to care for patients. While I am assigned my one to two patients, I also am assigned to a team, so we take a group report for the whole team of five to six patients.

It ensures that we are actively aware of our teammates’ patients and can help each other and cover each other’s breaks. We also sometimes have resource nurses that can help. In addition, all the doctors and attendings, NPs, etc. are on the unit with us and are very active in supporting us with patient care.”

-Denise, BSN, RN

Do you have a mentor or support system in place? How has that relationship impacted your experience?

“I think my preceptor was initially a mentor for me on the unit, but she works day shifts so aside from texting we only see each other at shift change. She is someone I can always reach out to if I need anything. Otherwise, I never really had someone that guided me through nursing school or as a new grad, so I try to be that person for others because I think it would make the transition so much easier.

It’s also hard to talk about the job with people who are not nurses because there is a large disconnect on what we experience, it just takes speaking to people who do the same job to understand.”

-Denise, BSN, RN

What measures do you believe could enhance nurse safety and security at work?

“A few measures I believe could enhance nurse safety and security at work would be, for example, implementing proper ‘searches’ of psychiatric patients brought into the ER. I once had a psychiatric patient brought in needing an evaluation. This patient did not have a proper search technique done which resulted in me getting cornered by the patient in their room with a switchblade being pointed at me.

Also, I believe continuous improvements for nurse safety and surveillance overall should not have to be a topic, but unfortunately it is. There have been too many times where the security system is down, and the emergency room is unable to utilize the camera for long periods of time. Without the use of cameras from time to time could become potentially harmful, especially if the hospital were to be on a lockdown from a threat.”

-Carsen, BSN, RN

Have you experienced any signs of burnout since you started working? If so, what were they?

“Unfortunately, I have experienced signs of burnout since I started working as a nurse. I have only been a nurse for a year and already feel as if I am ready to retire. This relates back to flexible schedules, nurse staffing, and patient ratios.

As an ER nurse, if you do not have something to do, then you are doing it wrong. For me, I experience a heavy patient load in most of my shifts which means I am constantly having to go from one task to another. This is by far the easiest way to begin feeling burnt out. Going to work every day knowing you will always be behind puts a lot of stress on you physically and mentally. The cherry on top is a non-flexible schedule mandating more weekends to an understaffed hospital to an already overwhelmed nurse.”

-Carsen, BSN, RN

healthcare worker burnout whitepaper

What policies or practices could be implemented to help maintain a better work-life balance?

“I was hired for night shift as a new graduate in the ICU, and I find that most of my difficulty with work life balance is primarily due to working nights and not because of the job itself. The biggest thing I would say to help promote work-life balance is letting nurses have as much flexibility with their schedule.

My hospital requires 13 shifts per four-week pay period (three shifts for three weeks, four for one week, and you must have four of those shifts be a Saturday or a Sunday). I know other nurses who also require 13 shifts but do not have specifics on how many per week are required, which would be more helpful on planning for life outside of work and sleep scheduling.

I would also say having resources available for mental health support, education on sleep habits, or health and wellness programs from hospitals. My hospital also has a new graduate residency, it required monthly meeting and covered important topics for transitioning from student to nurse. I wish it was tailored to be more specific for the unit you work in, but it was still a good resource and place to meet other new nurses in all different units.”

-Denise, BSN, RN

“Oh boy, as nurse this question alone could take days to answer. However, let’s start with the main priorities to maintain a better work-life balance, like ensuring adequate nurse staffing. Nurses are already the jack of all trades and ‘mother goose’ of the hospital, meaning we must know and do everything. Adequate nurse staffing would eliminate the need for already-tired nurses to have to pick up shifts or even having to stay later to help the hospital.

This leads to rapid burnout in many nurses, especially new nurses. Also, providing a safe nurse-to-patient ratio. As a nurse, I am preaching to the over-worked nursing choir. A safe nurse-to-patient ratio would not only provide a nurse with the means to provide better quality care, but also more efficient treatment at the hospital. The safe ratio would limit a nurse to only a certain number of patients that is deemed necessary and safe for the nurse to provide care. I work in the ER, and I speak with experience that too many patients with one nurse can lead to simple mistakes and once again, a burnt-out nurse.”

-Carsen, BSN, RN

“In healthcare it can be extremely difficult to find time to take a break. Some days it feels like everything that you need to do needs to be done urgently and so even taking a bathroom break is something that I may hold off on doing.

I think that the best way to help employees take breaks is to either improve nurse staffing or improve the nurses’ abilities to perform the patient care technician duties. When nurses take their breaks another nurse will cover their patients for them, yet where I work the same is not done for patient care technicians.

If there were a way for another person to cover for me while I was on my break, I would be a lot more inclined to not only take my break in the first place but to also feel relaxed during my break. Taking a break that is truly relaxing is vital to healthcare workers as it allows us to feel recharged. One the days I get a chance to call my partner during my breaks, I am able to return to the unit feeling much more refreshed and confident in my abilities.”

-Allison, Mental Health Nurse

If you could share one honest piece of feedback or make a suggestion to your nurse manager about your work environment, without any fear of retribution, what would it be?

“If I had to identify the biggest barrier to my learning it would be the culture surrounding new employees. I have found that a lot of the time the more experienced nurses and patient care technicians will have negative attitudes towards new employees, which makes it more difficult for new employees to ask them questions and learn.

Often, I see my coworkers complaining to each other about a new employee doing something incorrectly, and I wish that instead of doing this, they would address the issue with the new employee in a respectful way, so that they can learn from their mistakes.

Ultimately, there is a lot to learn working in healthcare and this learning never ends for those who are open to it. Having respectful and direct relationships with coworkers for me was the most important factor in adjusting to the job.”

-Allison, Mental Health Nurse

Learn more about nurses' concerns around workplace violence and employee safety in the first part of this series here.