Feeling like a failure

firstinfamily, RN · Sep 25, 2014

It sounds like you are having a hard time getting your feet on the ground!!! Triage nursing involves the ability to make decisions about the needs of patients and to do that you would have to have more experience. The job market is very tight right now, even for nurses, if you do not have any good references it is going to be hard for you to find work. Have you tried private duty? I am assuming you passed your Nsg. Boards because you have been employed as a nurse in three places. It would be nice if you could find a place that would take the time to put you with a mentor who could guide you and help you in performing critical thinking skills. These do not necessarily just occur, you have to know what to look for, how to prevent complications etc. That takes experience!! I would not want you to give up yet, but truly do not know how to advise you. If you like working with the public and you like to be challenged you should stick with it. Finding an employer who will devote the time you need to develop your skills is going to be difficult. Try volunteering in a healthcare setting to keep yourself in the environment. Have you talked to any of your nursing instructors to see if they had any ideas for you??

jadelpn, LPN, EMT-B · Sep 25, 2014

Do not get into a place where you feel like a failure. The non-tangible parts of nursing are sometimes more difficult to grasp.

You now know that BP medication is to be reviewed with an MD if a patient's BP is low. There is a LOT of variables to that, so you learned to use your resources.

Unfortunately to use said resources in the skilled care you were working at came back to bite you--and not knowing the whole situation, I am not sure what occurred, however, as a general rule using your resources are a good thing.

In your current position, start looking at the patient as a whole picture. Look at the chart and familiarize yourself with the patient. It is not a bad thing to know what the patient wants, what the patient needs, (which may not be the same thing) has the patient been taking their medications? How does the patient appear? What are the baseline vital signs?

Follow policy on what you are supposed to assess for the patient initially. But people who are concrete, black and white thinkers have the most difficulty with intangible information. Sometimes, by looking at the patient as a whole, head to toe, medication specific person with a change in function it is sometimes easier to grasp.

Triage is tough via the phone. It is not altogether easy for a seasoned nurse. So if this is something you would enjoy, really observe who is doing it now, and how they do it.

Finally, if the college that you attended has any nursing class on critical thinking, I would retake it. I would look at online avenues as well for nursing critical thinking skills.

learningext.com/nurses/p/critical_thinking.asp

Here's an example....

Good luck!

asix1961 · Sep 25, 2014

Thanks for your reply. Yes I went to the Dean at my school. She was suprised to hear that there are so many places that are unwilling to take the time to help develop new grads. At the doctors office where I work now, but am about to be let go, they told me that because I'm an RN I should have more critical thinking skills. Everything that I've read and people that I've turned to have said that comes with years of experience, yet no one wants to invest that time, they want everything right now. I feel I am doing a great job at the office that I'm at. I've only been there since June. I haven't been trained to do the triage nursing or blood draws but the one doctor feels I'll never have that ability. I don't think thats very fair. If you know where I might find that place that will mentor me please let me know. I'm so afraid of my continue failures. I'm a single Mom and I was about to lose my home before I took the job at the doctors office. I can't imagine losing this job.

asix1961 · Sep 25, 2014

Thanks I will check out that site. I just want to succeed. Just once.

NurseGirl525, ASN, RN · Sep 25, 2014

I'm going to throw this out there. Maybe nursing just is not for you. There is absolutely nothing wrong with that. Your career does not define who you are as a person. Some people are not cut out for certain lines of work. If you are licensed as a RN, you should have some critical thinking skills. What school did you attend? I agree that some of these skills will come over time and with experience, but you do need to have the basics. Critical thinking is one of the biggest things we are taught in nursing school. It seems that each job you have had is saying the same thing to you. But do not feel like a failure. Your job is just a small part of what you do in life. See if you can maybe take an online class in critical thinking as most colleges offer this class now, or find something else to do in life. I have worn many hats in my day and not every one was a good fit for me. I did not excel at everything. We all have our own niches in life, that is what makes us unique and great. If we all excelled at the same things, this world would be trouble. The world would be full of one thing, and we as a society would fail.

OCNRN63, RN · Sep 25, 2014

It seems there's a disconnect between the way you perceive yourself and the way your employers see you.

I think you should have a sit down with your physician supervisor and ask him to give you specific examples as to why he thinks you lack critical thinking skills. Have you had any problems with caring for the patients in the office?

Critical thinking skills are refined over time, but you have to have the basics of them when you start working as a nurse. Did you have problems like this when you were in nursing school? How did you do in your clinicals?

Is there another RN there who can give you the mentoring you need.

If there's a way you could do a refresher course, I'd suggest you look into it. I know you just graduated and have had work experience, but something isn't "clicking" with you.

I really hope you can turn this around. You worked hard to get through nursing school; I hope you are able to use it.

OCNRN63, RN · Sep 25, 2014

I'm going to throw this out there. Maybe nursing just is not for you. There is absolutely nothing wrong with that. Your career does not define who you are as a person. Some people are not cut out for certain lines of work. If you are licensed as a RN, you should have some critical thinking skills. What school did you attend? I agree that some of these skills will come over time and with experience, but you do need to have the basics. Critical thinking is one of the biggest things we are taught in nursing school. It seems that each job you have had is saying the same thing to you. But do not feel like a failure. Your job is just a small part of what you do in life. See if you can maybe take an online class in critical thinking as most colleges offer this class now, or find something else to do in life. I have worn many hats in my day and not every one was a good fit for me. I did not excel at everything. We all have our own niches in life, that is what makes us unique and great. If we all excelled at the same things, this world would be trouble. The world would be full of one thing, and we as a society would fail.

I thought the same thing. It may be a hard thing to accept, but we all aren't meant to be nurses, even if we want to be a nurse. I'm not meant to be an artist. I loved playing the piano, but even with practice I was never anything more than an intermediate level of skill.

Perhaps the OP would do better seeing a career counselor who could provide guidance regarding the best type of job for the OP. It would certainly be better than beating one's self up repeatedly for failure.

Ayvah, RN · Sep 25, 2014

I'd start by heading to your local library and getting a book on telephone triage to prep yourself. Also, get more familiar with the most frequent diagnoses that you see (i.e. diabetes, heart disease, etc, based on your specific department).

I'm not sure exactly what area in the office that you are having trouble with, so I'll just hit on a few points.

I think one of the biggest things in office nursing is that if you are rooming, you need to evaluate vitals, and ask yourself "why?", investigate further, and think of what would be needed to do next. For example, if a patient says they are having shortness of breath, go ahead and get a pulse ox on them before the doctor even asks. If they say they are feeling 'off', go ahead and get a temperature on them (if you don't normally). If the dynamap says that their blood pressure is low or high, ask "why?" and evaluate further. If it is low (i.e. sbp

Its also helpful to investigate any problems patients had with obtaining the medication yourself, by calling the pharmacy to see what the issue is (often times the problem will be different than what the patient relays to you). I've had it happen where the patient's medication is ready to be picked up but the patient had been confused and thought they couldn't get it for some reason or another. You can also call the pharmacy for clarification on what dosage of medication someone's taking. Likewise, if a patient or pharmacy leaves a message that the patient can't take a certain medication due to i.e. not being on the insurance formulary, take the initiative to ask the pharmacist what other options they recommend, before you speak to the doctor. Take advantage of your resources!

For triage getting a book will be very helpful to start to get comfortable with the general methods used. In general, what you'll want to do when a patient calls is to look at their last office visit note first, to get a general overview of their condition, to get a heads up if there are any outstanding issues with the patient and to see what the plan of care was. You'll want to ask the patient when their symptoms started, what part of the body, if anything triggered the symptoms (i.e. they were shoveling snow and then their ankle started hurting), if they are following the plan (i.e. if they ever took that med the doc prescribed them at the last office visit), if this has happened before and what has helped them in the past, and what they have already tried (i.e. ice, elevation)

If you have more specific areas of concern/questions just let me know and I'll do my best to help. Good luck!

asix1961 · Sep 26, 2014

This is my dilemma. I was married for 28 years and stayed home with my children all those years. Married right out of high school with no work experience. When I got divorced I decided to go to nursing school. I figured it would be a good job that would support me and I would be caring for people, which I love to do. I did very well in school and my clinicals and personally feel I've done well with the jobs I had for those short times. I was nervous of course but I did my best. I am 53 years old and I'm scared with the little experience I have and being told, lacking in critical thinking skills, that I can't compete with the younger nurses. What other career could I do now at this point in my life, not to mention the student loans I still have to pay? I just don't know what to do?

asix1961 · Sep 26, 2014

I just ordered a book on telephone triage. The office I work in is a Family Practice with 2 doctors and 1 PA. The one doctor is very hard to get along with. He belittles his nurses in front of everyone and the patients. He will just storm into the room while your getting vitals and trying to go over meds and tell you to get out you've been in here long enough. Apparently the office supervisor was told by someone that I have no critical thinking skills. That I don't report to the doctor if a patients blood pressure is low or high. When I take the BP I tell the patient what it is. If its high or low, I'll ask them if that normal for them or how they feel. The doctor thats hard to work with usually ignores me when I speak to him so I don't communicate much to him. He told me, just take the vitals and get out of there, so thats what I do. He has the vitals in the chart to see. The other thing that the doctor and the other nurses seem to have a problem with is how I learn. I have a notebook that I use to remember how to chart certain things that I don't do repetitively. Once I have that task concord I no longer need those set of notes. Thats just how I learn. I've been there since June and rarely use them anymore. I think its unfair to say I'm not capable of being a phone nurse when I was never trained or given the opportunity. It seems that once my training period was over, even though there were many things I was never trained on, the nurses including my trainer, no longer wants to help me or answer my questions. The PA that I work with said I'm doing an excellent job and told the supervisor she would hire me as her nurse. I believe it is just this hard headed doctor.

asix1961 · Sep 26, 2014

I honestly think that they all feel I don't fit in. I'm older and a new nurse. I get the patients to the room, take vitals, chart on what they're there for and then the doctor comes in. Its not rocket science. I did very well in school. I graduated with honors and did well in clinical. I know many of us didn't feel we were ready when we graduated though. I really felt that I would get more training on the job. I got 8 weeks on the first job and 10 on the second. The one I'm doing now I got 10 as well. I like the idea of a refresher course, I definitely need to look in to it.