Feeling Inadequate in Hospice Preceptorship

[Career2_BSN, BSN]

I'm doing my preceptorship in Hospice (my 1st choice). Up until now, all of my clinical experience has been in a hospital and I've gotten pretty comfortable with assessments, charting, med passes, etc in the hospital setting. The last two weeks of my med/surg rotation (before preceptorship), I was taking my nurses full loads and they were answering occasional call lights but I did most of the work. I felt like a nurse, like "I can do this".

Now, I find myself using all paper (no computers), the paper charts (3" thick or more) are at the office while we're out in the field, I feel unorganized with all of this paper shuffling and kind of lost without the patient's history readily at my fingertips. I didn't realize how convenient it was to see all of the previous charting so you can say "yea, his condition is the same" or "no, it's definitely changed" or "I see they gave him XYZ and that could be the cause of his problem". How nice it was to have lab values and now we're relying solely on symptoms.

Each time we walk out of a patient's home, I share my assessment and thoughts with my preceptor. She usually agrees with me, but then she brings up things she noticed about the patient (things I didn't pick up on) and I feel totally inadequate. For example, one patient had a sudden change of LOC along with a fever. We all thought infection, likely UTI since that's common. The preceptor asked me what I thought of his breathing. I told her breaths were shallow, on the slower side, and listening to the lungs, there didn't seem to be a lot of gas exchange. She agreed and thought that perhaps he was also having some CO2 toxicity and instructed the family to put his CPAP on until he showed signs of improvement. As soon as she said it, I'm thinking, "duh, why didn't I think of that? We had a lecture on that." There have been other smaller things, but this was the biggie that I felt like, I wouldn't have been what the pt needed at that time.

Going into our preceptorship rotations, our instructors cautioned us to set realistic expectations for ourselves. They reminded us, we are students and won't know everything. But, I can't help wanting so desperately to be everything my patients need and knowing I'm failing. I just don't know enough.

Anyone else feel like they just aren't enough? Any experienced nurses who remember having these feelings and grew past it? Do these feelings resurface anytime you move to a new dept or nursing function?