I'm so bad at my community job...

[calamityjane1]

I'm looking for some advice, or reassurance. Or something. Maybe I don't deserve any.

I've been qualified two years this month. Spent 13 months in acute surgical, in my 11th month in a rural community setting.

I have never been confident in nursing, I feel dumb no matter how much I study. Lately I've been feeling so rubbish at my job. I am often the only community nurse on for our patch, and obviously have to deal with things on my own, miles from anywhere, this doesn't bother me, however the decision making does. If its a straight forward injection or dressing, that's fair enough but I feel like the doctors expect me to automatically know things that my colleague does (she's been nursing for 40 years). I'm well aware I'm inexperienced compared to her, but I feel like I should be more experienced than I am, even though I've got loads to learn still and am still adjusting to moving from acute to community.

Anyways this thing happened when I was asked to see a patient (obviously can't go into too much detail). I did a brief examination, and should have performed a simple urine test, but I didn't, because I didn't see how these two things were connected, and in fact, it didn't even cross my mind. Kicking myself in hindsight, but there were two symptoms and they weren't typical symptoms of a UTI that I had ever come across. I reported what I'd seen to the doc, he asked if he had a UTI, I said I didn't think so with the symptoms he had (duh... I know). So I go into work a week later and he's in hospital albeit for a completely different thing but also shows he was positive for UTI. So someone checked it after me. Nobody has said anything to me, but the doc made a point of telling me that he was really unwell, which they don't normally do, they let us ask them. I feel so guilty. How can I get better at my job? I feel so rubbish, and I'm sure they think I'm a dimwit.

Should I be better than this at my two years post grad point? I can't believe I missed this, I'm worried I'll miss something bigger.

[dudette10, MSN, RN]

I'm just making a wild guess here...was one of the symptoms an altered mental status? And what was he finally admitted for?

To determine if you are failing at connecting the dots or the symptoms were so far removed from a UTI that no nurse would have suspected it, more info is needed.

However, when the doc asked, "Does he have a UTI?"--even if you didn't think the symptoms pointed to that--you should have responded, "I don't know. I'll go ahead a do a urine check and get back to you with the results."

Its possible that community is not right for you because you need more decision-making support. Community notoriously requires a lot of independent thinking on the part of the nurse.

[calamityjane1]

Thank you so much for your response. Redness was the only thing I saw, swelling occurred between me seeing him and my nurse colleague seeing him the next day, those were the only symptoms. Out of hours saw him after that. I know I should have done a test, as I said, I'm absolutely kicking myself mentally, pretty much physically too. The docs have had words with my colleague for doing things wrong before, and they haven't had words with me, I assume that they know that I've at least joined the dots now. Pity it wasn't sooner. He was asymptomatic otherwise, no confusion, no smelly urine, that's why I didn't suspect it. I'm so stupid. So stupid - not that I didn't think this before, but its definitely confirmed now I can't shake the guilt, and I'm too scared to go speak to the docs about it myself. At the very least it's a mistake I'll never make again, that's the only positive I'm seeing here.

[Ruas61, BSN, RN]

You're not stupid.

You are still young in your practice and you will gain knowledge and experience.

Unless you are making mistakes upon mistakes, you are okay.

Community nursing is a different creature than acute.

Plus, maybe ask to get your screen name changed to something a bit more positive. Unless you are really named calamity...

[mountst]

You are not stupid, you are searching for direction. Try to do your job not as a job, but as a service to people. Think that you are helping people who need help to make their days and improve their lives. You are caring for people, this is why you are called a "nurse." They need you and you are there for them. This is a great feeling. Things will change.

[LadyFree28, BSN, LPN, RN]

Instead if thinking that you are stupid (you are not btw), how about some self study? Pick up an fast check assessment book (like from the Incredibly Easy Series) and seek out assistance from you co-workers?

You can right this ship by righting your thoughts and self-studying...learning and honing your practice NEVER stops.

[pseudomonas, BSN, RN]

Instead if thinking that you are stupid (you are not btw), how about some self study? Pick up an fast check assessment book (like from the Incredibly Easy Series) and seek out assistance from you co-workers?

You can right this ship by righting your thoughts and self-studying...learning and honing your practice NEVER stops.

THIS. Also, I think you're being too hard on yourself and lack confidence in your knowledge and skills. With only two years of experience, of course you aren't as competent as you will be as you continue to grow professionally. Particularly considering you've entered a different area of nursing.

Plus, if you were so terrible at your job, wouldn't you have been spoken to by a supervisor regarding your performance, written up, or fired by now? :)

Learn from your mistakes, and keep your head up. Try not to be too hard on yourself. I'm a nursing student, and I've struggled with confidence and being too critical of myself. I think these issues are more common in nursing students and newer nurses than realized because many people keep their concerns and self-doubt to themselves.

Good luck to you.

[brandy1017, ASN, RN]

Are you an NP? If you are the just a nurse it is up to the Dr to diagnose not you! You learn by experience, now you know some additional things to look for a UTI for next time.

[SeattleJess]

Hey, calamityjane1, you need to change the way you talk to yourself! Remember, what we focus attention onto is what grows. I cringed when I read the words you say about yourself.

How about "learning?" How about "motivated?" "Accountable?" How about anything that's kinder and more accurate than the words you're using to describe yourself. Do you talk to your patients that way? Bet not.

The horrible truth is that everyone will make a mistake at some point, no matter how excellent he or she may be.

I'm going through an orientation now. Of course, I make mistakes. (I also do some pretty great things!) It helps me to imagine that I'm writing a training manual and developing procedures for those I will mentor in the future when someone else steps into my trainee shoes. Can you think of yourself as your own trainee? How would you talk to her? Maybe praise her for what she did well and advise how she could improve on what she does less well. Having confidence that she will learn and grow. Reminding her that nursing is a practice. Making my experience about something bigger than just myself is what helps me.

You don't need to be perfect, in fact you cannot be perfect. I, too, was surprised by some of the symptoms of a UTI the first time I encountered them in LTC. Now I know. You do, too.

It's also okay if community nursing is not for you and you want to find a different environment. That doesn't mean you're stupid, either.

:hug:

[Tigerlily8]

You are not a dimwit.You are being too hard on yourself. I recommend you purchase and carry a reference manual that aids in diagnosis. And call your colleagues, physicians, and ask questions, having a second opinion can be very helpful and a good learning opportunity for you.

[HouTx, BSN, MSN, EdD]

From a US perspective - the standard is to follow pre-detemined protocols & 'standing orders' to determine what diagnostic tests &/or follow up is needed. If your organization does not have something like this, maybe you could develop your own set of guidelines & 'what ifs' with the assistance of your tenured colleague.

[Guttercat, ASN, RN]

We all have moments where we feel incredibly incompetent.

This won't be the last time. Granted it gets better with more and more exposure to different disease processes, but there will always be an occasional "duh" moment. The moment you think you won't have one, is the moment you need to hang up the scrubs.

Over time, you will learn how to deal with these "duh" moments in a more constructive manner. You won't be afraid to talk to your docs, coworkers, and supervisors about it, and ask for feedback. You will learn, and move on.

Remember, each experience--even the negative ones-- only adds to your orificenal of knowledge and confidence. Now get back out there and do great things!