“If nursing was a book, then nursing school would be the table of contents,” one of my professors said.

Self-confidence is the state of belief that your thoughts and behaviors are correct. It is much sought, especially as a nursing student preparing for the end of school and the beginning of a hard-earned career.

As a nursing instructor, I have never been fond of the “fake it till you make it” strategy. Faking anything is sometimes easy to see through and can ruin trust.

Confidence Is Slowly Earned

We earn self-confidence, and others’ confidence, by gaining competence through practice. As a nursing student, you get approximately 56 twelve-hour shifts’ worth of clinical experience from start to finish. That is certainly not sufficient time to feel self-confident in nursing! But it is enough time to learn how to be safe and to recognize when it is time to stop and ask questions; this is competence.

During those clinical days, much of what occurs is at the mercy of the day: lots of admissions, low census, everyone is on PO meds, your assigned patient pulled out their IV and now is going home, a C. diff outbreak, a full moon—you get the picture!

Short of constructed experiences in the simulation lab, sometimes your clinical experiences are out of the instructor’s control, meaning everyone leaves school with a slightly different experience, and most feel insecure about their first nursing assignments.

Confidence in Knowledge

Nursing students and newly graduated nurses can be confident in their ability to accomplish nursing goals or tasks. What do they need to support this ability?

It is completely acceptable not to know the answer, direction, or decision. Nursing is vast, and so are the human conditions requiring nursing care. It is even OK, in most cases, to tell your instructor, preceptor, or patient, “I don’t know the answer, but I will find out.”

Knowing what your resources are is more important than knowing the answer. Hospital policies and procedures, the staff educator, and provided computer and text references are all excellent places to find the answers you need.

After you have been in one facility and one area of nursing long enough, the answers will just roll out of you like a walking encyclopedia. This usually happens around the second year of practice.

Confidence in Skills

Skills take time to develop. Muscle memory requires repeated attempts to get a thing done. There is no way around it.

In the beginning, observe the skills you need to strengthen when other nurses perform them: inserting an IV or an NG tube, accessing an implanted port, starting a drip, or running a code. Eventually, though, you have to jump in there do it yourself.

When you are a student, the instructor will usually be by your side. As a new nurse, a preceptor will be there. Even after orientation is over, if needed, grab a trusted nurse or the staff educator and ask them to come watch you.

Confidence in Decisions

Throughout your career, there will be times when you doubt you did all you could have or should have. It is only natural when faced with so much responsibility.

But when you are a new nurse, in a new area of nursing, or in a new facility, even the most routine tasks can leave you wondering if what you have done is correct. Experience is a great teacher, but no nurse wants that experience to come at the cost of someone in their care.

First, when you make a mistake, take responsibility for it, no matter how small or large. Then, consider what the lessons are in that mistake: How can you prevent it in the future? What happened that was within your control?

Learning from these situations is a terrific way to build confidence, even if it doesn’t feel good in the moment the mistake occurs.

Confidence in Communication

Do you often find that you feel inadequate when “put on the spot” to answer a question? This usually does not reflect a weakness in skill or knowledge, but simply a reduced ability to communicate when under scrutiny. The feeling might be expressed as this: “I would have known if you had not asked me!”

Speaking to a healthcare provider (HCP) in person or on the phone is another situation that can leave a new nurse feeling less confident in communication. Nothing quite prepares you for communicating with a healthcare provider. Initially, it is nerve-wracking!

Anticipate what is required and write it down. It doesn’t all have to be in your head. Few can manage that!

Do you think your instructor or preceptor needs to know the side effects of a drug you are about to administer? Make a few short notes to remind yourself, and use those notes!

Are you calling the HCP about a patient’s deteriorating status? Naturally, they will need vital signs, the most recent labs, and an idea of what the person looks like—and they do not have time to wait while you look it up.

You called them! Be prepared.

Confidence in Intuition

Nursing is a science. It is rooted in evidence. So where does intuition come in to play? Nursing is also an art: the creative use of self, based on expertise.

Expertise is the mastery of nursing knowledge, skills, communication, and decision-making in your area of nursing. Intuition is the intersection of your areas of expertise. Intuition is often used to avoid a crisis.

Intuition is a coveted and almost undefinable skill that takes time to develop. At first, intuition is little more than recognizing that something is wrong.

Later, intuition becomes actions that you begin to implement, sometimes without even being able to say why. It is a gut feeling that will often save your patient before anyone knows they need saving at all.

The more practice you get, the sooner your confidence will soar.