Feeling incompetent

NurseBeth7807 · Aug 23, 2007

I feel the exact same way. I am going though the motions charting, passing meds, etc. but I don't really GET it. I have no clue what's going on with my patients as a whole, and it makes me very sad. Nursing is not what I expected.

Imafloat, BSN, RN · Aug 23, 2007

I read the patient's chart when I have time (which is rare).

I have been on my own for about 6 months. My incompetence comes when things are extra busy or my patients have a high acuity. I can handle a normal assignment, but a patient going south, a new admit, or a bigger assignment than normal throws me for a loop. I am hoping at the end of another 6 months I will be more comfortable with these higher level assignments.

We have to be gentle on ourselves, Rome wasn't built in a day. I know it is easier said than done, I am very guilty of being my own worse critic.

SuesquatchRN, BSN, RN · Aug 23, 2007

You're a brand new nurse. You aren't expected to know all.

incublissRN, BSN, RN · Aug 23, 2007

After my first 6 months on a cardiac medical unit I felt the same way. I transferred to critical care because I was so unhappy and after 9 months in cardiac recovery I feel like I'm finally starting to understand my patients better. As you get better at time managment you will have more time to read your patient's charts and understand their progress and plan of care.

Daytonite, BSN, RN · Aug 23, 2007

. . .the patients and family sometimes ask me questions regarding their illness and i dont know how to answer them. it makes me feel so incompetent. . .is this one of the things that will come to me in time, with experience? maybe i should go back to the books...its just that after working these 12's the last thing i want to do is open a book and read about nursing.

if you want to continue feeling incompetent then don't open a book. that makes what you do just a job. however, to be a nursing professional you need to always be refreshing what you know and learning more. get out your books, particularly one on pathophysiology. or, buy a new one that will help you out here. i have a real nice one called pathophysiology: a 2-in-1 reference for nurses by springhouse, springhouse publishing company staff. pick an interesting patient that you had today or last week that you had some questions about. after you go home and have rested up for a bit, open up a book and start reading about that patient's disease--again, even if it's only for 10 or 15 minutes. i can also give you the links to some really nice web sites where you can find information very quickly on the internet as well if you'd rather take your poison that way. it never hurts to review this stuff. ever. you'll be surprised at what you missed or forgot about some of these diseases when you were in school. you'll also be surprised at how some of the medical and nursing interventions now start to make more sense to you after 6 months of practice. you'll also be more capable of answering patient's and family's questions about their disease and illness. there are hundreds of web sites with disease information for patients on the internet that you could be viewing or recommending to patients. this is part of our responsibility of being professional licensed nurses. learning doesn't stop the day we get our diplomas.

medline plus (use the search box) http://www.medlineplus.gov/
medem http://www.medem.com/medlb/medlib_entry.cfm?sid=103af635-c640-11d4-8c0100508bf1c1f1&site_name=medem
medicine net diseases & conditions a to z index http://www.medicinenet.com/diseases_and_conditions/article.htm
the mayo clinic
http://www.mayoclinic.com/
emedicinehealth first aid and consumer health information list of topics from a to z http://www.emedicinehealth.com/script/main/art.asp?articlekey=60185
national institutes of health http://www.nih.gov/
the various institutes and links to them: http://www.nih.gov/icd/ - there is major information about the top chronic diseases and their treatment on these u.s. government supported web sites that are well-worth exploring
family practice notebook (use search box) http://www.fpnotebook.com/index.htm - i post this website for students all the time because it lists nice concise lists of pathophysiology, signs, symptoms, diagnostic tests and medical treatment of all kinds of diseases
web md index list of medical conditions http://www.webmd.com/a_to_z_guide/health_topics.htm
merck manual of diagnosis and therapy http://www.merck.com/mrkshared/mmanual/sections.jsp
emedicine http://www.emedicine.com/ http://www.emedicine.com/specialties.htm - listing of specialties - these are physician continuing education articles about all kinds of medical diseases. you can either search for a disease using the search box or pull up a listing of them by physician specialty - you may have to register to view articles, but registration is free. this is part of web md.
who (world health organization) http://www.who.int/en/ - if you are ever looking for information on tropical diseases or disease not normally seen in the u.s., but is prevalent in other countries, the who has good information on their site.

Tweety, BSN, RN · Aug 23, 2007

You're exactly where you need to be.

Give yourself a break. Novice nurses tend to focus on tasks, but you're also doing good assessments and you are better at putting things together than you're giving yourself credit for. Concentrate on developing good habits and everything will come together for you with time. But we're never going to know it all and have it totally together. :)

For now challenge yourself during your assessment. Think "this patient is a post-op patient what should I focus on, what could happen?". This patient has rales, what could that mean? Look for the "what could happen if.........." as you go about your day with the patient.

Absolutely yes, these kinds of things will come with experience. One day a family member will ask and you'll say "from my experience, this is what might be happening.................." After 16 years I still say "I don't know........." because nursing/medical science is so complex and ever changing and there is just too much information to know everything.

deeDawntee, RN · Aug 23, 2007

I definitely agree that you have to do 2 things here:

1) give yourself a break...and really acknowledge yourself for how far you have come!!! Look at how many hurdles you have overcome!!! And no doubt, you would be able to recognize when your patient is going south!

2) keep a list of things you need to look up. When you have had a patient with a certain disorder, go home and read up on it, make yourself a 3X5 or 4X6 card on it, and be prepared to tell someone about it that knows nothing about it (your pt's and families). You absolutely need to be an educator as well...but it takes a while to be really good at it. Sometimes I will look something up on the internet and then print it off for the patient and family...your facility probably has websites that they approve of....that is always an option. But use that only as an adjunct to your teaching. Sometimes the patient's and the families will ask you things that are out of your scope of practice and then it is expected that you would have them ask the Doc. Usually I say that I will leave the Doc a note that you have questions about prognosis or diagnosis etc....

You are where you should be...it is good that you recognize what is missing in your practice without anyone having to point it out!! That is very impressive...now it is up to you to keep expanding your knowledge base. You are and will be an awesome nurse...I know it!!

:yeah: :yeah: :yeah:

AprilRNhere · Aug 23, 2007

I was told by a nurse the other night (and the others around agreed) that while they felt competent to DO the job...everything started really "clicking" and they started seeing the pt as a whole at 2 years. That sounds insane....but there's just so much to do. Remember...it's not all you. There IS a dr...and other nurses for the other shifts. If you don't feel comfortable about something...have another nurse look in on your pt.

maggie&sally · Aug 24, 2007

Hi, I was recently hired as a PRT and I am in my first rotation with PICU & NICU to follow. I dont know if this is for me, I love children and even dealing with angry parents does not bother me but I feel that my orientation was not enough. I am handling 3 patiets and the ratio is 6/1. I can barely handle 3 let alone 4 patients. anyway on my floor out of your six patients is a hemonc pt (very unstable pt) on top of that you are doing discharges and admissions, charting q 4 hr and mixing your medications of which some of your patients are on triple antibiotics. HELP!!. I sometimes feel as if I want to vomit before I go to work! I am thinking of leaving and going into a different area, anybody have any advice? I would like to work more closely with my pts.and get to know them I was thinking of going into hemodyalisis or some kind of clinic work, I am a new grad and do not know what to do, but I have worked so hard to attain my license the thought of making a mistake with too many patients scares me to death, anyone have any ideas about what I should do next?:uhoh21:

JazzyRN · Aug 24, 2007

this is normal for a new grad, but please do read and research conditions and complications. you will learn alot that way, any syndromes/disorders that your unfamiliar with, even if you just google it on the net, it will help solidify things in your mind. it takes time to really understand why things are occuring. If you really have interest in understanding pathophys., having time to study your pt's history and why things are happen, and being able to anticipate what can or will happen next, i suggest you work in ICU setting. You learn SO much during rounds on your pt, having only 1 or 2 pts gives you time enough to really understand. I gained so much of what I now know from working in the PICU. Esp if you have a really good attending that quizzes the residents and fellows on what is happening and why its happening during their presentation of a pt.

al7139, ASN, RN · Aug 24, 2007

I feel the exact same way sometimes. I graduated in May, and work on a very busy cardiac/med unit. I really sometimes feel like I don't know anything! I have found that I still refer back to my textbooks to refresh myself on the diseases and the process. It really helps when I am not sure if I really know whats going on. Then I can usually apply what I have read next time. As for those questions from pts/family, my favorite phrase is "I am not sure, let me find out and get back to you with that." You are not expected to know everything, and admitting you are unsure is OK, just make sure you really do get back to them! I also ask other RNs or even the docs on occasion if I see them on the floor, and they are friendly (some I would never ask). We are lucky that alot of the docs we work with regularly are into teaching, and like us to ask questions at appropriate times. Some have even made a point to introduce themselves to me and welcome me to the hospital and tell me not to hesitate to ask them about their pts. Also we have internet access, and that is a good quick resource as well.

Dont' worry, I am told that it gets easier!

Amy