Am I In The Right Place?

sbic56, BSN, RN · Aug 16, 2005

There may be less acute types of nursing, but I'm wondering if your fears are more real or imagined. Have you made mistakes or are you just alert to the possibility that you could make one? I'd say most of us need ayear to start to feel really competent, some require more and that's no crime. The fact that your managers are being supportive tells me they may have more confidence in you than you do in yourself. I bet it'll come.

Editorial Team / Admin · Aug 16, 2005

I am very frightened right now. I have only been a practicing nurse for a few months. This is my 2nd career. I've had 2 months in the hospital and 3 months working on a busy acute rehab unit. I could not handle the stress level of the hospital and so I got into rehab thinking it would be more manageable. This is an acute rehab unit and is almost as bad as the hospital where I used to work. I haven't been a nurse for very long and I feel unprepared for a lot of the challenges we deal with on a daily basis. We get some very unstable patients who can crash on us at any time, we have unstable diabetics who are tricky to manage, we're under a lot of pressure to get meds, treatments and charting done in a timely manner. There's also pressure on me to make sure I leave on time to pick my son up. Although the directors are trying to be helpful and supportive, I feel incompetent and wonder I if I should quit before something happens where I could lose my license. Once you lose your license that's it, right? Maybe I need to chose another type of nursing.

I'll bet you have received more experience in how to handle these situations than you think. You probably are just too hard on yourself.

Why not try another area? Maybe, clinic/office nurse. The hours are less...........usually no weekends...........no holidays...... more time to spend with family. Less pay, however.

Good luck in whatever you decide!!

Tweety, BSN, RN · Aug 16, 2005

Give it a little more time.

I deal with acutely ill patients that can crash at any minute too. It's what nurses do.

The fear you have is entirely normal and reasonable, I feel it every day. But I can't let it stop me.

You are competent because #1 you graduated from nursing school, #2 the state says you are as you've passed NCLEX, #3 they people that hired you think you are.....you just need a healthy dose of self-confidence and self-esteem.

Everyone of us experienced those feelings of fear and doubt at first. For a long time I longed to just give up my license and go back to being a tech because I felt too incompetent to handle "real" nursing.

If I can do it, you can too. Hang in there and good luck to you.

SmilingBluEyes · Aug 16, 2005

what agreat post from Tweety. And so true. Be kind to yourself and never be afraid to ask ANY questions. Never pretend to know what you don't. Good luck.

Happy-ER-RN, RN · Aug 17, 2005

You can't live in constant fear of losing your nursing license, that is just no way to live. I have been a new nurse in the ER for almost 3 months and I feel like you do. I think it just takes time to get used to everything and to learn. I have had a LOT of people tell me that it's the ones who aren't scared at this point and who think they know what is going on that are really having a problem and are a risk to their patients. So the fact that you are scared means you are right where you should be! I too have felt like running at times but I know if I tried something else I would be bored out of mind.

Good luck!

student4ever · Aug 17, 2005

Tweety, as always you have such wonderful things to say! I'm not a new RN yet, but I've just started a new job as a CA, with a lot of patient care responsibilities in a busy ER, and I must say there are days I want to go home and give up on my new job and to give up on nursing completely. It can be so overwhelming, especially after coming from a job I could do in my sleep! But the fact that I am aware that I can make mistakes tells me that I'm aware of my own limitations, and if I need help, I need to ask for it. It also causes me to check and double check myself - which is a good thing to do. Give yourself some time and some credit - I can't say it as eloquently as Tweety, but yeah... you'll do fine, just give yourself some time and believe in yourself!

Daytonite, BSN, RN · Aug 17, 2005

Unfortunately, nursing school can't totally prepare students for the actual chaos of a busy unit. It's just not the same when you are shadowing someone or managing just a few patients as a student. The pressure, as you've discovered, can be overwhelming. You haven't asked for opinions or advice, but I'm going to offer you something that can be very empowering for you and a very valuable tool. One of the best things you can do for yourself in order to keep some control is to self-evaluate your own performance when these "challenges" are over. I understand that you are busy with a child to raise, but this self-evaluation is also part of your education and you should try to make some time for it. At home, take some time to go back through your textbooks and notes on something that has been a "challenge" for you at work. Apply your nursing process to yourself. You collect your data (what happened at work, what your textbooks and notes say), then assess your performance. List, either on paper or mentally, what you did that was right and what you missed and should have done. Think about how you could have used the things you missed in your work scenario. Then, think about how you are going to handle the same kind of situation the next time it comes up. Sometimes you'll do very well the next time and sometimes you'll feel helpless again and not perform up to the standard you set for yourself. You just pick yourself up and keep on doing the self-assessment process because you will learn from it.

When I first started working on a cardiac unit we had a lot of people that got chest pain. Whenever I would chart the incident I would realize that I had forgotten to assess for SOB, or check the time, or ask more specific information about their pain. I finally typed up a one page guideline for myself (no computers in those days! :coollook: ). I still have it somewhere around here. It had a list of symptoms to look for and a guideline for charting an incidence of chest pain. Incidences of chest pain were the first time I started pulling up a chair and sitting with the patient for 5 minutes or so while watching for their response to nitroglycerin. I would pull this guideline and place it on top of my clipboard and refer to it while I sat with the patient. After awhile I didn't need the written guideline anymore, but it was like my training wheels until I got the hang of what I needed to be doing. Over the years I've done similar guidelines for myself for diabetes, seizures and handling chest tubes.

The first months working as a new RN are very stressful and laden with self-doubt and guilt that one is not performing perfectly. It was somewhere between 6 months to a year before I started to feel like I had a handle on things, and more like 3 years before I began to feel really confident and that I could handle most situations. The incidences of "challenges" begin to become less and less as you become more confident. However, they don't stop. Every once in awhile something will come along that will send me back to the books. This self-evaluation exercise has helped me all through my career. If you weren't advised to do something like this, you should consider trying it. It will help you feel more in control of your practice.

el0489 · Aug 18, 2005

Thanks. Part of my fear probably is imagined but I have made some mistakes that were pointed out to my attention. One of them was a serious mistake. This patient had multiple issues and was suffering from a CVA. I mistakenly gave him insulin when he wasn't eating. His blood sugar was 101 but that was based on his having OJ, which I didn't know only lasts 1/2 hour. The insulin was intermediate acting but he bottomed out and had to be given glucagon several times before he was sent to the hospital. It was scary. As I said, he has had multiple issues, including CVA history, renal failure, but I find the business of diabetes management very complicated.

There may be less acute types of nursing, but I'm wondering if your fears are more real or imagined. Have you made mistakes or are you just alert to the possibility that you could make one? I'd say most of us need ayear to start to feel really competent, some require more and that's no crime. The fact that your managers are being supportive tells me they may have more confidence in you than you do in yourself. I bet it'll come.

Daytonite, BSN, RN · Aug 18, 2005

Thanks. . .I find the business of diabetes management very complicated.

As I suggested above, I would go back into my textbooks and work up a little cheat sheet for yourself. Include in it, the facility protocol for handling hypoglycemia and assessing the patient's food intake. This is how you will learn it.

I also sent you a private message.

sbic56, BSN, RN · Aug 18, 2005

Thanks. Part of my fear probably is imagined but I have made some mistakes that were pointed out to my attention. One of them was a serious mistake. This patient had multiple issues and was suffering from a CVA. I mistakenly gave him insulin when he wasn't eating. His blood sugar was 101 but that was based on his having OJ, which I didn't know only lasts 1/2 hour. The insulin was intermediate acting but he bottomed out and had to be given glucagon several times before he was sent to the hospital. It was scary. As I said, he has had multiple issues, including CVA history, renal failure, but I find the business of diabetes management very complicated.

It sounds as if this patient was very comprimised and even though he may have received more insulin than he should have, I don't believe that was the sole reason for this type of reaction. There was probably alot more going on systemically that wasn't fully understood. As you said, along with a CVA, he had renal failure. He might have ended up in the hospital anyway, but happened to crash on your watch, which even though was exacerbated by too much insulin, was not the typical insulin reaction. I am sure this incident prompted you to do some extra research on these conditions. This is how we learn, by our experiences and also by our mistakes. Seize this as a great learning moment and realize you are now that much wiser!

krob0729 · Aug 18, 2005

Unfortunately, nursing school can't totally prepare students for the actual chaos of a busy unit. It's just not the same when you are shadowing someone or managing just a few patients as a student. The pressure, as you've discovered, can be overwhelming. You haven't asked for opinions or advice, but I'm going to offer you something that can be very empowering for you and a very valuable tool. One of the best things you can do for yourself in order to keep some control is to self-evaluate your own performance when these "challenges" are over. I understand that you are busy with a child to raise, but this self-evaluation is also part of your education and you should try to make some time for it. At home, take some time to go back through your textbooks and notes on something that has been a "challenge" for you at work. Apply your nursing process to yourself. You collect your data (what happened at work, what your textbooks and notes say), then assess your performance. List, either on paper or mentally, what you did that was right and what you missed and should have done. Think about how you could have used the things you missed in your work scenario. Then, think about how you are going to handle the same kind of situation the next time it comes up. Sometimes you'll do very well the next time and sometimes you'll feel helpless again and not perform up to the standard you set for yourself. You just pick yourself up and keep on doing the self-assessment process because you will learn from it.
When I first started working on a cardiac unit we had a lot of people that got chest pain. Whenever I would chart the incident I would realize that I had forgotten to assess for SOB, or check the time, or ask more specific information about their pain. I finally typed up a one page guideline for myself (no computers in those days! ). I still have it somewhere around here. It had a list of symptoms to look for and a guideline for charting an incidence of chest pain. Incidences of chest pain were the first time I started pulling up a chair and sitting with the patient for 5 minutes or so while watching for their response to nitroglycerin. I would pull this guideline and place it on top of my clipboard and refer to it while I sat with the patient. After awhile I didn't need the written guideline anymore, but it was like my training wheels until I got the hang of what I needed to be doing. Over the years I've done similar guidelines for myself for diabetes, seizures and handling chest tubes.
The first months working as a new RN are very stressful and laden with self-doubt and guilt that one is not performing perfectly. It was somewhere between 6 months to a year before I started to feel like I had a handle on things, and more like 3 years before I began to feel really confident and that I could handle most situations. The incidences of "challenges" begin to become less and less as you become more confident. However, they don't stop. Every once in awhile something will come along that will send me back to the books. This self-evaluation exercise has helped me all through my career. If you weren't advised to do something like this, you should consider trying it. It will help you feel more in control of your practice.

Wow...what a post. I am definately going to take this advice.Thanks for sharing it with us. Too bad they don't share 'little' things with us like this in Nursing School.