Feeling Overwhelmed & Incompetent

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Hey everyone.. So I'm currently in my third week of night shift, second week off of orientation - and I can't help but feel like I am constantly making stupid mistakes. I worked last night and had two patients who would be NPO after midnight. One of them had been complaining of a terrible headache all day and had been getting Percocet whenever he could. I gave him his 930pm dose and around 11 he was asking for more but would not be due until 130am. After speaking to the residents about what to do for him, they advised me to have him try to hold out until 130am. At 130, he asked for the med and I gave it to him, completely forgetting he was NPO!! Then at 615, one of my other patients desatted to 68% from a coughing fit and everyone was rushing to her bedside, and my headache patient was asking for more pain meds. This time I was preoccupied with my more emergent patient so I quickly gave him his Percocet like an idiot again and rushed to my second patient. At her bedside, I felt completely incompetent. Luckily I knew enough to call the residents to come for help but when one of the picu nurses who happened to be on our floor that might came I. The room and completely took over the scene, I felt like a complete idiot. And to make the situation worse, when I gave report to the day shift nurse who pointed out that I stupidly gave Percocet to an NPO patient, I just wanted to go home and cry.

It was my third night in a row, and I was exhausted, but I know that is no excuse. Luckily the patient I gave the meds to wasn't scheduled for the OR until that evening, but that was pure luck. Everyone at work is telling me I'm doing okay and that we all make mistakes, especially as a newbie, but I can't help but feel like I leave work after every shift with at least one mistake. Luckily I feel like the big things I am able to pick up on, but it's hear little things that most people assume is common sense that I seem to miss.

I don't know what to do and I can't help but think that maybe this isn't for me if I can't seem to pick up on these very obvious things. These "little mistakes" could potentially become life threatening, and if that were to happen I would never forgive myself.

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Oh gosh, if I had the opportunity, I'd probably be the same way. I am really good at the hard stuff, but the simple things confound me. I have found that I have to stop myself from going into an autopilot mode. That's where mistakes happen. Stop, take thirty seconds, even talk to yourself out loud if you have to and say, "Have I thought of all the steps and factors surrounding this issue?". Just focusing totally on that moment can direct you to that little something you might not remember by being hyper-focused on just the problem at hand. You were probably feeling bad for a patient in pain and were focused on pain management. I had a patient desating and I got so focused on getting those numbers to go up that I neglected to check the obvious (o2 tubing became disconnected). I figured it out, but I kicked myself for not checking that first. I got stuck on checking the patient first and almost forgot to move to checking the equipment next. I have never made that mistake again. It made me realize I have to step back and remember my training and follow it methodically as a novice RN. Eventually, I'll get to the point of just knowing. You will too.

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Hello,

I too am a new grad who work nights and I just finished my 6 weeks orientation a few days ago. I work at an urban hospital downtown and the pt acuity is high and its faced paced. So I must say I feel the EXACT same way. I make silly mistakes and feel like I'm not smart enough and I get so overwhelmed. And just when I think "okay my night is going pretty good" something happens to smack me right in the face and throws everything off. From what I hear it gets better and better, and God am I hoping so. I've had moments where I wanted to break down and cry and one time I actually did. Sorry I don't have any advice I'm still trying to find my footing myself, hopefully it'll get better for the both of us. Keep me posted.

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Specializes in Emergency Nursing.

LOL. NPO for Surgery generally doesn't mean that you can't give anything by mouth. Meds and small sips of water are fine.

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ScottE,RN - LOL. unfortunately for him it meant meds as well.

But thanks for the reassuring encouragement from everyone else.

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Ugh, I hear you! It's SO hard being new! I really am trying my best, but know I miss stuff or do something stupid. Everyone has been great though, and will usually tell me if I miss something or whatever. I wish orientation could be like 6 months! :p We'll get there though. Everyone started out with the same fears and insecurities and they somehow managed, right?

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Are you on a MS floor? I feel the same exact way! OMG. It's hard, especially we don't know much about nursing yet. Keep your head up high, we'll get there eventually.

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Specializes in Family Nurse Practitioner.

Deep breath!

Ok, for one, unless the scheduled procedure is at 7 am and they need to be NPO for at least 6 hours, giving your patient a pain med is not going to hurt.

Also, many patients are NPO except for meds. One percocet pill is not going to make a major difference. Patients go to the OR all the time having taken meds before. I generally give my patients going to surgery all their main daily meds, especially BP meds, unless the doc specifies not to give the meds. I will hold insulin if they are not eating and oral diabetes meds if their blood sugars are low. If they're on anything that affects blood clotting - heparin, coumadin, plavix, aspirin etc. I will ask if they should get it.

You will make more mistakes. Hopefully not big ones. It's impossible to be perfect at everything you do.

You will be fine!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

The first year of nursing is the most difficult, and it's impossible to overemphasize that point. The first year of nursing sucks. It bites big time. It's really, really hard.

Everyone makes mistakes. Absolutely everyone. There is no one alive who has not made a mistake, and the only nurses who say they haven't made a mistake are either lying or too stupid to realize they've made a mistake. Fortunately, you're not in either of those categories. Go you!

I probably would have given the Percocet to the NPO patient with a couple of sips of water even if I *HAD* remembered about the NPO status. Yes, it would have been better had you remembered, but that's probably not the worst mistake you'll ever make. If everyone at work is telling you that you're OK, you probably are. Let that reassure you.

We all make mistakes. As you progress in your practice and gain experience, your critical thinking will improve. When everything isn't new and different, things that aren't normal will stand out more, and you'll notice them faster. (Or at all.) You just need more experience.

It's OK to decide that nursing isn't for you, but please give it at least a year first. It takes that long to begin to be competent. We need conscientious nurses like you!

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I feel the same way as you, I'm still on orientation but everyday when I go home I obsess over things I should have done differently. Though I do feel like the whole npo thing isn't a problem, I've noticed most surgeons order "npo except meds" so it is usually ok to give important meds.

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I'm feeling the same way! I'm just off of orientation in an ICU and it's very stressful. My days off are filled with dread of going back to work. I hate feeling this way. It's making me second guess hospital nursing. I know everyone keeps saying it gets better, but I feel stuck because the job market is so bad right now and I am trying to transfer out to a lower acuity unit, with no luck so far. I'm considering school nursing at this point as well. I have 9 months of hospital experience, but I'm afraid to leave the hospital because I worry I may not be able to get back into hospital nursing in the future if I want to. I'm stuck!!! Advice please!!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I'm feeling the same way! I'm just off of orientation in an ICU and it's very stressful. My days off are filled with dread of going back to work. I hate feeling this way. It's making me second guess hospital nursing. I know everyone keeps saying it gets better, but I feel stuck because the job market is so bad right now and I am trying to transfer out to a lower acuity unit, with no luck so far. I'm considering school nursing at this point as well. I have 9 months of hospital experience, but I'm afraid to leave the hospital because I worry I may not be able to get back into hospital nursing in the future if I want to. I'm stuck!!! Advice please!!

Stay where you are and try to change your attitude a bit. The first year of nursing is incredibly difficult, but you're almost there. Keep at it, and you'll have a year of hospital experience. Yes, I know you're miserable and dread going to work -- we've all been through that. Somewhere around the year mark, something just "clicks" and you go to work feeling capable of getting through your shift without drama. Things come up and you can handle them . . . or you can't handle them but find out what you need to know to handle them the next time and it's OK because you learned something. You've put in nine months; you're almost there!

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