Feeling VERY Incompetent

[kyfitch]

So, I am now in my very last semester of my BSN program, and now is the time that I am preparing for the NCLEX as well as creating a solid resume to apply for jobs. The problem is, I feel VERY inadequate and not confident at all in what I have "supposedly" learned while in school, and the skills that I have "supposedly" been shown in clinical rotations. I feel like basic knowledge that I should have a grasp of I just simply don't know. I honestly believe that if I were to pass the NCLEX, any institution that hired me in would immediately fire me after seeing how incredibly incompetent I am. I know that we aren't supposed to know everything as a new grad, and I also know that minor mistakes will be made. However, I also know that basic knowledge is expected and I really don't feel like I'm anywhere near prepared as far as knowledge base or clinical skills goes in order to be able to practice. Can anyone please give me some advice on what I should do in this situation? I do not want to be "that guy" when I become a new nurse on the floor.

[Workitinurfava, BSN, RN]

The best advice I can give is despite how you are treated or feel you are being treated by your preceptor, ask for help. No question is a dumb question when you don't fully know what you are doing.

[kyfitch, BSN]

The best advice I can give is despite how you are treated or feel you are being treated by your preceptor, ask for help. No question is a dumb question when you don't fully know what you are doing.

This has definitely been one of my issues in the past for sure. You hit the nail right on the head. I want to ask questions but most of the time I feel as though we are penalized for asking questions even though we are told to ask questions. If you ask questions it literally shows the instructor that you don't understand something, so they mark you down. How are you supposed to learn if you can't ask questions? This has always been a big issue for me. Then people wonder why you didn't learn something when you are in a job. "You should know this, why didn't you ask questions when you were in training?" Uhhhhhhhh...... because I didn't want to be failed out of my nursing program and never actually get to work as a nurse.........

[Meeshie]

I think we all feel inadequate at the start. Nursing school doesn't prepare you to be a nurse... it prepares you to pass a test and it gives you the general knowledge you need so you can build on it. You learn to be a nurse by being a nurse and having good preceptors. Remember, especially in a hospital setting, you are never alone. There will always be people you can ask questions of, brainstorm with, collaborate with.

I started in a residency program and the knowledge seriously varied person to person.. every school taught differently. You'll be okay as long as you want to learn, are eager to learn, and understand when you need to ask for clarification. It all comes together in the end.

[kyfitch, BSN]

I think we all feel inadequate at the start. Nursing school doesn't prepare you to be a nurse... it prepares you to pass a test and it gives you the general knowledge you need so you can build on it. You learn to be a nurse by being a nurse and having good preceptors. Remember, especially in a hospital setting, you are never alone. There will always be people you can ask questions of, brainstorm with, collaborate with.

I started in a residency program and the knowledge seriously varied person to person.. every school taught differently. You'll be okay as long as you want to learn, are eager to learn, and understand when you need to ask for clarification. It all comes together in the end.

I really appreciate your knowledge on this subject. It really does make me feel a bit better and gives me a bit more confidence.

[emmy27]

One of my (dearly beloved) instructors as a student made the comment, when someone expressed concern over feeling like she wouldn't know everything she needed to be a staff nurse, "You definitely won't. You will know enough to be educable when you begin, and you will learn the rest in your specialty."

I actually took some comfort in this, and over the years I've realized how true it is, and how it's not only true of new grads- few if any nurses, even those with years of experience, know enough to thrive in every specialty without additional training and education, even if it's informal and on the job. Nursing school and licensure is there to ensure you have a base of universal knowledge- anatomy, physiology, pharmacology, pathophysiology, and nursing theory, along with a few basic tasks- things that will mean you aren't totally at loose ends when you're handed to a preceptor- you will understand their rationales as they teach you, you will be able to comprehend the whys behind the whats and hows of policies and procedures. Everything else will be- almost must be- picked up as you go.

Pay attention, look things up, ask questions, don't be afraid to admit when something is new or confusing to you, and you'll be fine.

[roser13, ASN, RN]

This has definitely been one of my issues in the past for sure. You hit the nail right on the head. I want to ask questions but most of the time I feel as though we are penalized for asking questions even though we are told to ask questions. If you ask questions it literally shows the instructor that you don't understand something, so they mark you down. How are you supposed to learn if you can't ask questions? This has always been a big issue for me. Then people wonder why you didn't learn something when you are in a job. "You should know this, why didn't you ask questions when you were in training?" Uhhhhhhhh...... because I didn't want to be failed out of my nursing program and never actually get to work as a nurse.........

I've always been a big question-asker. What I learned during orientation was the ART of questioning. The who/what/when/where of asking questions is crucial to know. Here are a few of the biggies.

Questions don't necessarily need to be asked when they arise. Some can wait until a calmer, quieter moment. Make notes to remind yourself of the question.

Questions don't necessarily need to be asked of the one who was there when the question arose. They usually can be asked of another nurse; say, one who appears to be more open to questions.

Questions don't always need to be answered by someone else. Some questions can be researched at home or on your next break.

Questions should always be asked in a constructive, non-confrontational way. Believe it or not, I've had orientees fire questions at me that were barely disguised as questions. Instead, they were more of a challenge as to why or how I did something, when the why/how apparently did not conform to a pre-conceived notion.

Just a few "rules" that come to mind.

[foggnm]

You are incompetent! You are a student with no experience! It will be OK!!!!! You will gain competence and confidence in your first year or two. I had an internship on a med-surg-tele floor when I was in nursing school so felt very prepared when I started. But even if your experience is limited, just don't stress yourself out about it. If you read through the allnurses board you will find hundreds of posts by stressed out nursing students. Just relax, finish school, and be open to your future. You will have no end to the possibilities for experience, learning, and employment. Stay cool and be professional!

[Been there,done that, ASN, RN]

Sounds about right. I did not you-know what from shinola as a new grad. I had a 3 month orientation and I learned to be an adequate nurse.

You will be surprised how it all comes together, once you actually start practicing nursing.

During orientation, review the diagnoses you deal with and continue to learn in the real world. Know who you can count on for guidance.

Most of us felt the way you do. You CAN do this.

[djh123]

Whoah, whoah. You are DEFINITELY not the only person who feels like this in your current situation. Sure, there are people who are all fired up and feel like they can do anything, but some of them aren't as great as they think they are (ok, some ARE as good as that, but only some).

This was covered similarly in a previous thread. You have to remember that you've been taught the basics - and if your school was anything like mine, some of those were taught well to you, and some weren't.

I didn't work at a LTC/rehab facility by choice ... I just kind of ended up in one. And I was taught very little. A lot of what I do every single day I picked up on the job, but a lot of what I had in school was the foundation for those things, and is in the back of my mind when I'm trying to diagnose what's happening with someone.

Never turn down an opportunity to learn something, always do the best you can, and you'll probably do fine. And btw, after almost 4 years in my job, I don't always feel super-competent, and I could tell you a skill or two that I'm not that great at (because I haven't had to do it many times and therefore haven't built up the competence). But in many areas, I DO feel competent.

[Ruby Vee, BSN]

Hello, looking for work. Thanks for the reply. I live in Michigan, and I am hoping to be able to get a job in Grand Rapids, MI once I finish nursing school. I keep hearing about how much nurses get treated horribly, and I know it will happen to me for the reasons explained previously. I just really hope that I can learn quickly enough to not be harassed and keep my job.

I can't speak to the difficulty (or ease) of finding work in Michigan, but someone has done you a huge disservice by convincing you that there are bullies everywhere and you'll be lucky not to be harassed. While it is true that there is the occasional bully in nursing, they are no more prevalent than in the law, the Police Department or anywhere else where people are employed. Some PEOPLE are bullies, and there are no more bullies in nursing than you'll find anywhere else. Nurses are not treated horribly -- unless you go looking to be treated horribly. Seems like you generally find what you look for, so why not go looking for friendly, helpful colleagues who will mentor you, show you teamwork and have your back?

[Ruby Vee, BSN]

ummm sorry roser13, but I am a realist, not a cheerleader at a pep rally. I had no access to these internet comment forums when I made the decision to go to nursing school. Wish I had. My decision was made due to the fake propoganda that there was a dire nursing shortage, loads of fake "sign on bonuses" appearing in the classified sections, and the overall feeling that if you were a good person, a smart person and a hard worker you would be able to excel in this field. I was mislead, and now I have a ton of debt that I cannot pay off. I have been made miserable by the profession itself. I have given 200% on every shift I ever worked and got back nothing but aggravation, verticle/horizontal bullying, a lack of even basic respect from co-workers or superiors, and found myself constantly changing jobs because of the hell hole environments that no sane person can tolerate. Sorry its not all rainbows and butterflies. On the upside, I met some truly wonderful people who experienced the same abuse as I did, left their jobs, and then left the entire profession. I keep meeting more and more people who have left nursing behind, have transitioned to lower pay work to save their sanity, and those who stay in it out of sheer fiancial necessity and nothing else. A fellow nurse co-worker told me that she refused to pay for her kid's education if she chose nursing. Another realist. The truth hurts, but it is necessary.

If you're constantly changing jobs because everyone you meet is a bully, perhaps you need to take a look at what YOU are bringing to all of these jobs. If you meet one jerk, they're a jerk. If everyone you meet is a jerk, then YOU are the jerk.

The truth hurts, but it is necessary.

[Ruby Vee, BSN]

The best advice I can give is despite how you are treated or feel you are being treated by your preceptor, ask for help. No question is a dumb question when you don't fully know what you are doing.

Ask questions. Ask lots of questions, but please don't ask dumb questions. There is, contrary to popular belief, such a thing as a dumb question.

Instead of asking "What's the number for X-ray again?" ask "Where can I find a list of frequently used phone numbers for other departments?" The dumb question would be "Mrs. Pee needs a Foley. What do I do?" Instead, ask "I have an order for a Foley for Mrs. Pee. I've looked up the procedure and I think I have everything I need. But I've never done this before, so would you please go over it with me before we go into the patient's room?"

Carry a pocket notebook, and when someone answers a question that could easily become a dumb question of you ask over and over, write down the answer. The next time the question comes up, you won't have to ask.