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Feeling incompetent

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So, I have been on the floor almost 6 months. I am finally starting to feel comfortable....getting into my own little routine. I know what is expected of me to get the "job" done (paperwork, meds, etc.) BUT....I am feeling like sometimes, I really dont UNDERSTAND what is going on with my patients physiologically. I feel like I am so busy that I dont even have a chance to think about whats going on. THAT SCARES ME!!!! Another thing is that 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 :o

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. Does anyone else feel this way?

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

Has 13 years experience.

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.

incublissRN, BSN, RN

Specializes in CVICU, PACU, OR. Has 10 years experience.

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

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience.

. . .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.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

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

Specializes in Travel Nursing, ICU, tele, etc. Has 12 years experience.

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

Specializes in RN- Med/surg.

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.

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

Specializes in PICU/Peds. Has 5 years experience.

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

Specializes in Emergency. Has 5 years experience.

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

You know....I have been sitting here thinking about how much time I DON'T have to break out books and review, but honestly there are times when I have 3, 4, even 5 days off between shifts. I am going to invest in a good patho book.....one that is maybe a bit more reader-friendly than my Med-Surg text...and really start applying some knowledge.

I became a nurse so that I could make a difference, and have a career that challenges me and pushed me the extra mile. Well it is definitely doing all of the above! This thread has inspired me to stop talking about how "lost" I am feeling and really go for it!

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.

That's a very good point, that the docs and nurses on the next shifts are all extra eyes on the patient and should be able to catch anything you miss, just as you'll sometimes find things that they've missed.

To me, this makes me question the wisdom, then, of having brand new nurses working 12 hours straight with a full load of patients. Yes, the new nurse will generally have at least 8-12 week with a preceptor working up to a full load, but as others note, it's not until a year that most new nurses feel like they're not just barely getting by by the grace of God. So during that year, for each shift, the new nurse ISN'T confident in their skills and abilities in that incredibly varied and hectic role as an acute care nurse. Add to that, it's a full 12 hours before the newbie is relieved and any inadvertent mistakes can be caught. Yes, the new nurse needs to ask for help and ask questions, but one usually doesn't know they missed something until someone else catches it.

Hmm... if new nurses only worked partial shifts at first, they might not feel as overwhelmed. They'd learn how to handle several patients at once, which they need to do, but if there'd be less time to get behind as their replacement would be there sooner and if the newbie were behind the next nurse wouldn't have as much catching up to do. And the newbie wouldn't be so wiped out from working a full shift that they'd be too tired to go look up and review what they need to.

I know, a scheduling nightmare! But I honestly don't think new nurses should be considered as equal to experienced staff when it comes to staffing numbers - after all, if the newbie is expected to rely on her/his colleagues for support, then they are yet another demand upon the experienced staff and that *should* be accounted for in staffing.

If it truly takes a year to feel competent, then that means working for a year feeling less than competant. And something seems wrong with that.

AprilRNhere

Specializes in RN- Med/surg.

jjjoy......I agree with parts...BUT>..if we could only work partial shifts.....I do believe the statistics of new nurses would drop considerably. I couldn't afford to pay my student loans if I worked partial shifts.

Where I work...they aren't considered equals. I love the facility I work at. They're fair and wise. The nurses that were oriented last summer are just now only taking 5 pts....rarely if EVER given the full work load of 6 pts. The charge nurses just know what they're capable of..and what's safe. THey seem to work well together. They'd rather give them a lighter load..that they can handle...than have them begging for help anyway because they can't get caught up.

I graduated in 2004 and worked home health for a while. Then I decided to try the hospital setting and It was pure **** at first. I dreaded coming to work, and even called in on occasion after a terrible experience the previous night. But I stuck with it and Just when I started kind of liking it and feeling a LITTLE bit comfortable, the hospital closed it's doors and we were all without a job. That was in May 2006. Since then I have not worked, but just stayed home with my new baby. I really want to go back to work now but am so scared of starting over. I'll have to get used to new co-workers, new doctors, and I am afraid I have forgotten alot too since it has been over a year since I worked. Does anyone have any advice or had a similar experience that might help encourage me to not be afraid of returning to work?

every nurses feels that way too. but nursing is a continous learning, so you should update your self every now and then...

Curious1alwys, BSN, RN

Has 9 years experience.

Hmm... if new nurses only worked partial shifts at first, they might not feel as overwhelmed. They'd learn how to handle several patients at once, which they need to do, but if there'd be less time to get behind as their replacement would be there sooner and if the newbie were behind the next nurse wouldn't have as much catching up to do. And the newbie wouldn't be so wiped out from working a full shift that they'd be too tired to go look up and review what they need to.

I know, a scheduling nightmare! But I honestly don't think new nurses should be considered as equal to experienced staff when it comes to staffing numbers - after all, if the newbie is expected to rely on her/his colleagues for support, then they are yet another demand upon the experienced staff and that *should* be accounted for in staffing.

If it truly takes a year to feel competent, then that means working for a year feeling less than competant. And something seems wrong with that.

Once again, JJJJJJOOOYYY, we are in agreement!

I know partial shifts would be GREAT for me! I think I'd rather work less hours and work everyday at first than work those huge 12's that turn into 14's. I am so dog tired by the end of the shift...not only from the physical labor but from the THINKING that all I want to do is go home, put my feet up, and forget that I chose this profession, lol. Forget about researching diseases! I want to, but then.....you know.

And yeah that with the newbies not being counted in the staffing ratios. That would be so much better in a perfect world, lol

And yeah, a year to feel competent????? That SUCKS. Something IS wrong with that, I am right there with ya! No wonder so many new grads end up with anxiety and depression! Who wouldn't????:o

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