Not Cut Out to Be a Nurse?

Nurses General Nursing

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I just finished my first year of a two-year BSN program. I also work at an outpatient health center as a clinic assistant, where I've been for almost two years. I am absolutely, 100% certain that nursing is what I want to do with my life, and from working with nurses and healthcare professionals for several years I know what I'm getting into.

I feel like the deeper I get into clinical rotation, and observe my peers, the less confidence I have in my ability to be a nurse. It's also reflected in my job. The NPs at my work have always seemed frustrated with me; I've always gotten great feedback from clinic managers about my performance, but the providers only point out things I do wrong, and I feel like I make a lot of little mistakes every time I work.

For example, today I had a patient with a preexisting condition who wanted to do a procedure. She told me a little bit about her condition and I went and found the NP to ask how she wanted me to proceed. She seemed annoyed that I had not already anticipated asking questions about the treatment and outcome of the condition (the patient was reticent to provide more information), and sent me back into the room. The second time I asked more in depth questions and requested she get records from her specialist, then reported back to the NP, who was now REALLY annoyed because I had not educated the patient about an alternative option if the NP decided she could not do the procedure.

It's always stuff like this--little things that add up: I didn't get a clean catch because the patient's symptoms didn't clue me in to a UTI; I didn't do a pregnancy test because the patient insisted she'd been consistent with condoms, even through her period was three months late.

I feel really incompetent all the time, and think my lack of confidence just fuels my mistakes. I never do anything to jeopardize patients--if anything, I'm overly cautious. No one has ever approached me directly about it, but whenever the NP asks, "why didn't you do this"? I imagine that my coworkers think I'm slow, stupid, incapable of doing my job...and fear for my future as a nurse. What if I'm just not able to think analytically? What if I'm not cut out to be a nurse because I can't think for myself? Does everyone struggle with little things like this, or am I a hopeless case?

FloatRN19

126 Posts

Don't let their issues and frustration get you bogged down. Why didn't you think of these things at times? Probably because you're not an NP, your not even an RN yet. All that will come with time and hard work. Everyone has little things they struggle with, everyone.

Libby1987

3,726 Posts

For example, today I had a patient with a preexisting condition who wanted to do a procedure. She told me a little bit about her condition and I went and found the NP to ask how she wanted me to proceed. She seemed annoyed that I had not already anticipated asking questions about the treatment and outcome of the condition (the patient was reticent to provide more information), and sent me back into the room. The second time I asked more in depth questions and requested she get records from her specialist, then reported back to the NP, who was now REALLY annoyed because I had not educated the patient about an alternative option if the NP decided she could not do the procedure.

What's your position again? I don't know of any level of care where the provider doesn't have this discussion with the patient.

So far I don't see an example of why you're not cut out for nursing, only that the NP might be expecting you to perform outside of your scope.

Purple_roses

1,763 Posts

If there's anything I've gleaned from this site, it's that there's always lots to learn. A lot of nurses will tell you that you won't truly be an exceptional nurse until a few years after completing school. Just focus on learning from your mistakes.

I think every student feels incompetent most of the time. For every new thing you learn, you discover a new mountain of information that needs to be learned. It's a lot. But honestly, your mistakes don't seem horrible to me...no indicators that you can't become a great nurse.

TheCommuter, BSN, RN

102 Articles; 27,612 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I concur with a previous respondent: the NPs at your place of employment might have unrealistically high expectations and may want you to complete tasks that are outside an unlicensed worker's scope of practice.

Let's put it this way...I've been a nurse almost 10 years and am not expected to anticipate treatment decisions or read the providers' minds as if I have a crystal ball.

Seems to me it's the NP with the problem, no you. As a medical assistant, you cannot be expected to anticipate treatments OR do patient education.

wanna_be

67 Posts

I work with an organization that trains assistants "in house", so we have a slightly different role and scope than traditional medical assistants, including patient education, injection/phlebotomy, conducting intakes for exams and screening for STDs, etc. Everything I mentioned is within that scope, but yes, I am expected to anticipate tests/procedures (although it wasn't part of our training), and have found that I'm not very good at gathering the information the NP needs without explicit instructions. I've been at the same job for two years and every NP I've worked with seems annoyed/frustrated that I am not more on top of it. In school I also feel I'm not as quick to react to situations as my peers; despite being near the top of my class grade-wise, and having a good "bedside manner", when it comes to simulation lab, I usually have to think things through before acting, whereas everyone else in my group jumps in and gets things done with confidence, almost as if it's second nature. Just feeling like I'm too slow to learn or integrate concepts, and I'm afraid that once I graduate, when I no longer have someone holding my hand, that I'll be in big trouble as far as meeting all my competencies as a nurse :(

Jules A, MSN

8,864 Posts

Specializes in Family Nurse Practitioner.

While I agree that it sounds like the NP should be the one educating the patient on procedure options the red flags I see here are that the OP has worked that job for 2 years and is still struggling and that the feedback seems consistent across the board from more than one provider. Some of my feedback might be jaded because I am a NP now but in particular not getting a pregnancy test on a female patient who has missed menses because she said she consistently used condoms is eye raising for me. I could care less if she's the Virgin Mary if she is under 50 and has a uterus she needs a pregnancy test. I always educated patients and requested a clean catch for urine it is non-invasive so it doesn't seem to make sense not to request they wipe first unless of course its just a u-tox or hcg perhaps.

OP, I'm not trying to bash on you and I totally applaud your honest and insight. Although I don't think the few things you have written are enough to say one way or the other because trust me I have done plenty of silly things over the years however I do think it is wise for you to reflect on your goals. Is there a way to compile your feedback from evaluations and narrow down the major complaints? More importantly do you still want to be a nurse? If you have changed your mind thats totally ok also because this is not for everyone. Part of the reason I got my LPN first was because I wasn't even sure if I would like nursing and didn't want to spend years of my life working toward something that might not be my cup of tea. Best wishes and if you can narrow down specific areas you struggle with perhaps we can help you strategize here.

Libby1987

3,726 Posts

I don't consider a urine pregnancy test as protocol for anyone with a missed period as a procedure or falling under the umbrella of decision making, that's simply a protocol to follow, like taking VS on every patient.

I think I have misunderstood the OP and thought she was being asked to perform outside of her scope.

wanna_be

67 Posts

Thank you for the constructive criticism, Jules. Yes, it scares me to death but at the same time I need some honest feedback instead of just a pat on the back. I haven't changed my mind at all about becoming a nurse, but I just don't know how to pinpoint what's wrong. Everyone seems angry/annoyed with me all the time. I'm not stupid; I have a previous B.A. in public health and this is my second degree. I seem to work better at a slower pace, where I'm able to think things through rather than on my feet. I want to get better, and I hope it's just a skill that takes time to acquire. Although I have worked there for two years, the past year I have worked once or twice a month due to school, so it's possible that I would improve getting back into the swing of things. Like I've said, no one has ever said something directly to me. The Hcg/UA issues are less of not recognizing a risk of pregnancy/UTI and more not wanting to run unnecessary tests. I know it's important to take precautions, but if, for example, a patient comes in with a Hx of BV and states that they have some irritation with burning occasionally, I've hesitated to get a clean catch in the past, my thinking being that the irritation is d/t BV and not a UTI. I understand the logic behind ruling out a UTI but in the moment it seemed reasonable, until the NP pointed out why she wanted a clean catch. That's what makes me feel stupid--I should've anticipated it. I've gotten better at just doing everything I can possibly think of when a patient comes in, and if I do something wrong once I will absolutely change my strategy in the future. But it always feels like there's something that I miss, some little thing that the NP has to remind me about. I have social anxiety, so it's possible I'm just overly sensitive/over analyze things that are normal, but that's what I'm trying to figure out--whether those little mistakes add up to make it or break it. The situation I described with a patient who wanted a procedure, I didn't want to give her unnecessary information unless I knew for certain she wasn't eligible for the procedure, but I understand from the NPs perspective that giving her that information prior to consulting with the NP would've saved time. I just felt like an idiot for it, and the NP was obviously annoyed. It's been seven years since I decided I wanted to be a nurse, but I just feel like I'm going to keep making mistakes forever. In simulation lab, too, my peers just seem so good at knowing what to do next and I always have to take a step back and think about it, more than anything because I don't want to do something wrong and I don't feel confident in my skills. They (my peers) tell me that they're just "faking it til we make it" but I just don't have that sort of confidence.

wanna_be

67 Posts

I'm also curious if there's some way I could get feedback directly (from my lab instructors, or the NPs at work) without wasting their time or seeming overly paranoid about my abilities. Do you all think it would be okay to ask to schedule a time to meet and talk to them about my performance? Our NPs our rotating, and do not manage clinic assistants, so it's not their job to give me feedback, but when I ask my manager she tells me I'm doing a great job and always get good feedback from the other staff, so I presume she's just oblivious to how terrible I am.

wanna_be

67 Posts

It was never explicitly stated to me that it's a protocol...it has sometimes seemed random/up to the discretion of the provider, which is why I've been confused about it in the past. I see a lot of patients with LARCs, progestin-only, and continuous use contraceptives, so a missed period is not an uncommon thing, and it is not always a given that the NP will ask for an Hcg. It's the unique cases where a patient already has irregular MPs that I've sometimes missed getting a sample. :-/

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