I'm afraid that I'm a bad nurse.

Nurses General Nursing

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Hello All:

I am a relatively new nurse (practicing 8 months). At the time I started my first job, I entered with the excitement and enthusiasm that accompanies most new endeavors. Although nervous and extremely stressed, I persevered through my first few months with few incidents.

But I find myself consistently plagued by a sense of dread. This feeling that I am missing something. During my shift, the tasks seem overwhelming. Tasks.... Even with CA fantastic 5 pt ratio, the needs of my patients can be too much for me to hold. I wish I could pull up a chair, converse with my clients... be in an environment that isn't wound up so tight at the hilt... anyone get my drift?

Perhaps Med/Surg just isn't my niche.

I have considered searching out opportunities outside the hospital. Perhaps home health, primary care, or even pursuing an advanced practice degree.

I know this post is a bit dis-jointed. And maybe it's just the rain outside talking. But I'm desperately afraid that someday, all the little things that I've missed because I've felt so under the gun are going to come crashing down. I don't want to be that nurse.

Anyway, any thoughts are appreciated. It's good therapy for us all.

Cheers.

Specializes in Telemetry.

uh, frankly in today's medicine if all my patients are alive and 80% comfortable when I leave then I did a good job. I don't care if my charting was done all the way, I don't care what meds I've forgot, and I don't care what management's complaints are. I'm sorry, we're to over loaded, and if someone wants to take my license away, go for it. I do what I can and that's it.

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You care. From what you said I don't think you sound like a bad nurse.

Try to remember that New Grads aren't considered able to work confidently and independently until they have at least 12 months experience. You have a lot of knowledge to connect with the benefit of the experience you are getting so it all can slowly come together for you.

Unfortunately ward work is hectic most of the time now. You do what you can, when you can. Make the minutes count.

Here, we RN's shower patients too. That's where most of my deep and meaningful conversations with patients happen.

Just remember to look after yourself. Do what you can in your time off to replenish your care bank. Then you always have something to give and those minutes you can enjoy with your patients will be enough to keep you going.

You are like an apprentice RN. It is hard for everyone.

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op, it sounds like home health is what you're looking for, it has it's pros and cons. that's the great thing about nursing, so many ways to be a nurse.

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Specializes in Med Surg, Perinatal, Endoscopy, IVF Lab.

""i have been doing this job for a lot of years and i rarely go home feeling like i didn't miss something. i think it's part of the job. can you ask for a review from your peers to see what they think?

cut yourself some slack. you have only been a nurse for 8 months and med/surg floors are busy. you have to multi task a lot.

have you thought about icu? more intensive but less patients?""

i agree with this... i haven't been doing it long either and i am in the same boat as you. but i walk around with the knowledge that you can please some of the people all of the time, all of the people some of the time, but you can't please all of the people all of the time. with so many patients, we can't meet everyone's every need. some of them just get the basics... especially the ones that don't call out much and aren't "needy" (you know what i mean). but there is always those one or two pts that need a little extra and those are the ones i focus on and pull up a chair with.

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Also don't let patients manipulate your time. You have to be firm but professional. For example, walk into your first patient's room and say: Hi Mr/s _____ I have 5 patients today, I can spend 15 minutes doing your obs (or whatever), that way the patient has a realistic idea of how much time you can spend with them. Tell them when you walk in the room you only have so much time to perform a certain procedure (like checking an IDC for example). ALWAYS ask is there anything you need URGENTLY before you leave a room, saves time with ringing bells (but not always).

I'm really surprised your supervisor allows you to say this to patients. :confused:

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oh my gosh, you are sooo not a bad nurse.

you need to read the "First Year After Nursing Licensure" forum and you won't feel so inadequate.

you've come far already.

give yourself and time, a chance.

https://allnurses.com/first-year-after/

leslie

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I think every nurse at ANY level that is worth her weight, has felt that very same thing at one point or another. I think it's when you STOP asking if there is something you missed or could have done different, or should have done different, or, or, or... that's when you should reconsider career choices. You are a brand new nurse. I have been an RN for a very long time and only just recently found my "dream" job. Look around, try new things, relax a little and try to enjoy the ride :clown:

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I have though about ICU, and I have seriously considered it. But part of me (perhaps the "grass is greener syndrome") is looking outside of acute care altogether and leaning more towards primary care. My nursing program kinda shortchanged me a bit in that arena, but we were in a rural area with little clinical space, so I am looking at shadowing opportunities at local clinics and seeing if that's a better fit. Regarding home care, it sounds like a dream come true, but before I am eligible for most positions I would need a few more years in the hospital.

So we'll see. My year review is coming up and my DON is fantastic. I feel completely comfortable bringing this up with her.

ICU is NOT MS with only 2 patients. It is everything about your MS pt. amped up by a quotient of 10.

Definitly not a relaxing area. If you want more of the emotional hands-on type of nursing, than look at home health or Hospice nursing.

You spend ALOT of time with the families in ICU, but much of it is NOT theraputic. Most of it is traumatic, sad and very frustrating.

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Specializes in LTC, Med-Surg, IMCU/Tele, HH/CM.

You will always feel like your are forgetting something.

When I started in acute care I had a check-list of things that I needed to complete for each patient. Assessments, VS, I+O, charting. If someone needed to have their foley removed I wrote it down. Dressing changed? Wrote that down.

Crossing things off my list really helped me manage my time, and I wasn't constantly second-guessing if I had done something or not done something.

After a while the list got burned into the back of my eyeballs and while I still write down non-routine things, every item on that list is mentally crossed off by the end of the shift. And if it's something like a qday dressing change that I didn't get to -- well that is why we have nurses working 24 hours a day. Once in a while you'll have days where there just isn't enough time to get that one extra thing completed before the next shift comes on.

It takes a while, probably a bit longer than 8 months, but once you have the routine things streamlined you will find time to spend with your patients. An assessment is a really great time to talk with your patient, find out about them, plan their day. I usually spend at least 15-20 minutes with each patient during their first assessment (my patient load is 3 - 4).

And of course my organization recommends hourly rounding. You may already be doing this, but you will find that hourly rounding really decreases the use of call lights and bed-wetting emergencies. When you check on the patient ask them "Do you need to use the bathroom? Do you have pain? Are you hungry or thirsty? Is there anything else I can get for you while I'm here? I'll be back in approximately one hour".

I agree with the above poster that the ICU can be more stressful than floor nursing. While I don't steadily work in the ICU, I sometimes float there. Of course I take some of the less critical patients but I get to see everything that goes on. They have more codes than any other unit which can be stressful and of course dealing with the family can be tricky at times.

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Wow, I relate to this so much. It took me two years to finally reach the understanding that I am not a bad nurse, in fact I am a good one by a reasonable standard.

I may not be considered a stellar nurse by everyone - I miss meds from time to time and my charting is not always spot on, but I provide safe care and I am compassionate towards my patients needs.

I have learned that, your confidence is the only thing that will make you appear better than you are. If you walk on a floor and act like you are awesome, people will pick up on that and encourage you. If you are timid, people will follow up with making you feel incompetent.

It is all BS.

Humility in health care is a good thing. Even the Hippocratic oath commands doctors to never shy away from saying "I don't know". But this is not how we were taught. Nursing school teaches you it is dangerous to ask questions. How many of us have heard "you should know that"?

I was targeted on my first floor and constantly told I was a bad nurse and I was going to "kill someone one day". Finally I had enough and told them I would quit if they didn't stop. They agreed (cause they were despret for nurses) and backed off.

A couple days later, I noticed my pt was showing cognitive changes so I informed the doctor and literally RAN her down to get a CT. Since I actually talk with my patients, I knew something was wrong.

When I got back, my manager chided me because the patient was "probably faking" cause she didn't want to go home.

Turns out the pt was having a hemorrhagic stroke. If that patient was under my managers care, she would have died but may have lived because I was her nurse. That was very eye opening.

Another time a nurse reported me to management because I ran an abx ivpb w/o spiking it. The manager said, "yes we can fill out a med error report but first I have one for you to sign for the same mistake".

So understand, that people's view of your skills is only subjective to what they see for a brief moment of your practice. Only you can truly know if you are a good or bad nurse.

If you truly, do unto others as you would have them do unto you: it is almost impossible to be a bad nurse, even if time management is your week area for now.

The reality is, we are not set up to succeed in this profession. We are understaffed and over worked. You will make mistakes and you will feel like a bad nurse sometimes, but that doesn't make it so.

You need to just do the best you can and wash your hands of it at the end if the day. You simply aren't paid enough to deal with that stress and liability.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

Maybe you are a bad nurse; on the other hand, maybe you're just new. We don't work with you so we can't know if you're a good nurse or not. But at eight months, you would be doing well to be an "on the way to becoming competent nurse." That feeling of dread you describe, the feeling that you might be missing something . . . it never completely goes away. But with experience, you'll find that it sits WAYYYY in the back of your mind and when it does pop up, you really ARE missing something. With experience, you'll know when to listen to that little voice. Right now, the voice is overactive. Check and double check, but don't drive yourself crazy.

Five patients on Med/Surg can be busy, but at 8 months, any assignment will be busy. Perhaps Med/Surg isn't your niche, but it's darned good training. A competent Med/Surg nurse will find it far easier to transfer to another position and pick things up more easily. You, however, are not competent yet. That takes at least two years. Please don't put pressure on yourself to become a great nurse before you've had the time to learn the job, learn the profession and become competent.

You WILL miss things; you will make mistakes. You're human, after all, and no human is perfect. The fact that you're worried about it speaks well of you. Just hang in there. It gets easier. With eight months of Med/Surg under your belt, you're well on the way. One day you'll find that it just "clicks." And that day you may find that you like Med/Surg. Or at least you'll be very clear what you do like and don't like about it.

Hang in there!

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I have about 1 shift out of 4 when I feel like I've really connected with a patient or family, taken the time to talk to them about their feelings or educated them. Usually it's the ones who need education before going home, so that time is allotted into the patient assignments.

To the others, I tell myself they are in here mostly to get treated for the medical condition. I am not ever going to see them again, I am not their friend.

That does NOT mean I don't deeply care about my patients, because I do. Every one of them. I try to make a 5 minute conversation count for something towards their confidence in the hospital or making them feel like we care about them. I have good "listening ears" to try to draw out the information that's important to the hospital stay.

The bigger satisfaction is seeing that my nursing care (the medically related interventions) is helping them to get better or be more comfortable. Not letting their pain get out of control, propping them up so they can breathe better, alerting the docs if something is getting worse, being able to quickly act on an emergent situation.

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