Ever Feel Inadequate?

Nurses General Nursing

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Hi Everyone,

I have worked in various departments and facilities as a nurse with five years of experience. I was also an ER Tech before becoming a nurse. I am in a new department, a Med/Surg Tele. My background has been mostly float pool and in ER, ICU, SNF.

In my new setting and reflecting back on my career, I often feel like a complete failure. On my commute home, all I can think about is what I should have done, could have done, and did not do right. I do realize hindsight is 20/20 and I have never broken any rules or hurt a patient. I think I just beat myself up constantly for not being good enough. I look at all my coworkers and I always think about how much better of a nurse they are, compared to how I feel about myself.

I find that I am personally better with things outside of direct patient care and that is my future goal, but I do really want to learn more about floor nursing before going into another role.

Do you ever feel this way? Any tips? I would just like to leave work every now and then and think to myself, "Wow you did an awesome job today". Rather then, "Wow how did I survive today" or "Wow I suck".

Thank you!

Specializes in Hospice.
I agree, one day we might be able to get safe, acuity based ratios.

Don't hold your breath on any of that happening in the foreseeable future.

Right now, nurses are a financial drain on hospitals and facilities; they pay us, but we don't make them any money. Unlike physicians and NPs, nursing care is not billed separately. Matter of fact, our salaries are rolled into the daily room charge.

Like we need any more confirmation that we really aren't all that important to our employers.

Specializes in Float Pool - A Little Bit of Everything.
Don't hold your breath on any of that happening in the foreseeable future.

Right now, nurses are a financial drain on hospitals and facilities; they pay us, but we don't make them any money. Unlike physicians and NPs, nursing care is not billed separately. Matter of fact, our salaries are rolled into the daily room charge.

Like we need any more confirmation that we really aren't all that important to our employers.

I am actually writing a paper on this right as we speak! There is a TON of peer reviewed research and articles indicating that nurses actually have one of the biggest impacts on the bottom line. Nurses are directly related to patient satisfaction scores which are directly related to third party reimbursement. We are also directly related to things like hospital acquired infections, patient mortality rates, fall rates, etc. By having safe nurse to patient ratios, research has shown that nurses save facilities millions of dollars. Plus, safe nurse to patient ratios directly impacts job satisfaction which leads to a decrease in turnover and that saves millions of dollars. Here are some of my articles, check them out.

Allen, D. (2013). Evidence shows staff ratios can work. Nursing Standard, 27(43), 20-22 3p. doi:10.7748/ns2013.06.27.43.20.s28

Congress.gov. (2016). S.1132 registered nurse safe staffing act of 2015. Retrieved from S.1132 - 114th Congress (2

Specializes in Hospice.
I am actually writing a paper on this right as we speak! There is a TON of peer reviewed research and articles indicating that nurses actually have one of the biggest impacts on the bottom line. Nurses are directly related to patient satisfaction scores which are directly related to third party reimbursement. We are also directly related to things like hospital acquired infections, patient mortality rates, fall rates, etc. By having safe nurse to patient ratios, research has shown that nurses save facilities millions of dollars. Plus, safe nurse to patient ratios directly impacts job satisfaction which leads to a decrease in turnover and that saves millions of dollars. Here are some of my articles, check them out.

Allen, D. (2013). Evidence shows staff ratios can work. Nursing Standard, 27(43), 20-22 3p. doi:10.7748/ns2013.06.27.43.20.s28

Congress.gov. (2016). S.1132 registered nurse safe staffing act of 2015. Retrieved from S.1132 - 114th Congress (215-216): Registered Nurse Safe Staffing Act of 215 | Congress.gov | Library of Congress

Duffin, C. (2012a). Major study confirms link between nurse staff levels and care quality. Nursing Standard, 26(30), 7-7 1p.

Duffin, C. (2012b). Nurse-to-patient ratios must increase to improve safety. Nursing Older People, 24(4), 6-7 2p

Historic ratios breakthrough. (2015). Lamp, 72(7), 15-15 1p.

Martin, C. J. (2015). The effects of nurse staffing on quality of care. MEDSURG Nursing, 24(2), 4-6.

Nickitas, D. M. (2014). Investigating in nursing: Good for patients, Good for business, and Good for the bottom line. Nursing Economic$, 32(2), 54-69 16p.

Tevington, P. (2011). Professional issues. Mandatory nurse-patient ratios. MEDSURG Nursing, 20(5), 265-268 4p.

That may be, but until the daily bedside care that nurses provide can be billed and the hospital can receive payment for it, our contribution to the bottom line is pretty much invisible to TPTB.

Another point-physicians have a large say in where their patients go for treatment. So keeping them happy is a huge part of the hospital's agenda. A happy doc is an admitting doc.

Specializes in Adult MICU/SICU.

This is the perspective I've come away with 22 years after graduation: there is always someone who may appear to be smarter, sharper, or better with these mad skill sets or experiences we compare ourselves to privately - but are they, or do they just appear more confident? Do they just carry themselves as if they are the best of the best? That in itself is an art form.

Life is always that way - there will always be some people who excel, others whom emulate that, and all other people who fall to either end of the spectrum. There will always be someone more XXX than I (and others less) … and others you'll just never know for sure about.

Finally (finally) 2 decades into nursing am I okay in my own skin. Eventually we all get there at different rates, but there is a lot of pressure in life to be the very best. I'm also betting with the experience you mentioned that you have these amazing skill sets of your own some of your own coworkers are privately admiring without you even realizing it. Such is life my friend.

Keep in mind that your employer picked you over many qualified candidates - all whom got through a rigorous nursing program. And perhaps ask yourself this: What exactly do I feel inadequate about in my nursing skills? How do I feel I could be even better? How can I change that?

Again, you are not alone in your feelings. I believe we all have a time or two when we privately pull out the mental yardstick to measure ourselves against others in life and from time to time feel inadequate, but more often than not we aren't. Perfection is a pretty unattainable goal to achieve (believe me - I've tried).

With the experience you mentioned this old nurse would be proud to have you as my nurse any day.

Specializes in Cardiovascular recovery unit/ICU.

I can totally understand where you are coming from!! I had to take more than ten years off to raise sick kids. Two of the three were severely asthmatic. I just completed an RN refresher course and did 180 hours clinical in a Med/surg/tele floor. My experience is in cardiac critical care though I worked my way through school as a CNA on a tough floor. Anyhow back to the tele floor. I was given 5 pts with 2 admits and 1 discharge. That is way too much! Half the pts were on fall protocol. Even though they were on a camera view at the nurses station that did me NO GOOD as I was usually in another room performing tasks. One pt even had a cardizem drip going with PVC's in bigeminy. I was so OVERWHELMED!!! It got better as the weeks went along but I just wasn't happy and I was afraid I had missed something. I admire those nurses on med surg and their time management skills. They are truly amazing. For me though I took a position in cardiac critical care when clinical was over. I'm just wired that way. It's just as hard but in a different way. Hang in there and watch those nurses who have good work ethics and time management skills. Best of luck to you!!

Specializes in Float Pool - A Little Bit of Everything.

That is why professional nursing has to continue to advocate for the impact we have on healthcare. In many settings, nursing functions are billed for. For example, when I worked in an ED Observation Unit I did utilization review for the unit. I had to audit charts and mark what services the nurse performed at the bedside and they were directly billed for that. Of course it is different for the inpatient patients. The setting determines many of the things that nurses do, which we can bill for. Hence the reason much of what we do gets double charted in EMR, that way those of us doing utilization review can pull data for billing, statistics, etc.

The biggest factor for payment that nurses are impacting is value based purchasing. As this system continues and grows, facilities will be forced to see the impact nursing has on the bottom line. When I worked in business, in my first career, you had to see the value in long term savings and indirect savings. TPTB know this, it is business 101, they just prefer to see a savings or reward upfront. Often times to their detriment.

Specializes in Float Pool - A Little Bit of Everything.
This is the perspective I've come away with 22 years after graduation: there is always someone who may appear to be smarter, sharper, or better with these mad skill sets or experiences we compare ourselves to privately - but are they, or do they just appear more confident? Do they just carry themselves as if they are the best of the best? That in itself is an art form.

Life is always that way - there will always be some people who excel, others whom emulate that, and all other people who fall to either end of the spectrum. There will always be someone more XXX than I (and others less) … and others you'll just never know for sure about.

Finally (finally) 2 decades into nursing am I okay in my own skin. Eventually we all get there at different rates, but there is a lot of pressure in life to be the very best. I'm also betting with the experience you mentioned that you have these amazing skill sets of your own some of your own coworkers are privately admiring without you even realizing it. Such is life my friend.

Keep in mind that your employer picked you over many qualified candidates - all whom got through a rigorous nursing program. And perhaps ask yourself this: What exactly do I feel inadequate about in my nursing skills? How do I feel I could be even better? How can I change that?

Again, you are not alone in your feelings. I believe we all have a time or two when we privately pull out the mental yardstick to measure ourselves against others in life and from time to time feel inadequate, but more often than not we aren't. Perfection is a pretty unattainable goal to achieve (believe me - I've tried).

With the experience you mentioned this old nurse would be proud to have you as my nurse any day.

Thank you so much! I would be honored to work alongside such an insightful and experienced nurse! I think you are right, more self reflection is required on my part as to WHY I feel the way I do. I was thinking about it last night, and I wondered to myself if having been comfortable and successful in another career set me up for beating myself up for not being that way with nursing. I have to remember I am still in infancy with bedside practice, 5 years is a relatively short period of time. I think like you said, perfection is impossible and I should be kinder to myself. :-)

Specializes in Float Pool - A Little Bit of Everything.
I can totally understand where you are coming from!! I had to take more than ten years off to raise sick kids. Two of the three were severely asthmatic. I just completed an RN refresher course and did 180 hours clinical in a Med/surg/tele floor. My experience is in cardiac critical care though I worked my way through school as a CNA on a tough floor. Anyhow back to the tele floor. I was given 5 pts with 2 admits and 1 discharge. That is way too much! Half the pts were on fall protocol. Even though they were on a camera view at the nurses station that did me NO GOOD as I was usually in another room performing tasks. One pt even had a cardizem drip going with PVC's in bigeminy. I was so OVERWHELMED!!! It got better as the weeks went along but I just wasn't happy and I was afraid I had missed something. I admire those nurses on med surg and their time management skills. They are truly amazing. For me though I took a position in cardiac critical care when clinical was over. I'm just wired that way. It's just as hard but in a different way. Hang in there and watch those nurses who have good work ethics and time management skills. Best of luck to you!!

Thank you! I feel that way and these nurses are truly rockstars! The amount of pressure, acuity, discharges/admissions, doctors, special testing, etc. is out of control. I definitely look up to them as well, a big part of the reason I want to do this for a few years! Best of luck to you too!

Specializes in Adult MICU/SICU.

Nurse love thy self XOXO

Specializes in Float Pool - A Little Bit of Everything.
Nurse love thy self XOXO

I am so posting this on my locker! LOL, will use it to motivate the forces!

I'm a relatively new nurse in the same with rehab. How many patients do you have I'm up over 20 right now?

Specializes in Float Pool - A Little Bit of Everything.
I'm a relatively new nurse in the same with rehab. How many patients do you have I'm up over 20 right now?

Hi,

It has depended on the setting I am working in. Right now on a Tele floor I am 6 to 1. In the ER I was 4 to 1. In the ICU usually 2 to 1 but sometimes the house sup would give us a few Tele holds. In SNF, your setting, I had 30 to 1 in one facility and believe it or not 40 to 1 in another. In that second facility I had a mix of skilled and LTC patients. They had one floor that was only skilled patients and the ratio was 26 to 1. The madness must stop!

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