Feeling incompetent with this nurse role

nursebenson · Nov 28, 2006

Awesome bible resource! Thanks:smiletea2:

maximaxi · Nov 30, 2006

Yikes! I realize I only have 2 more weeks of orientation! I feel like I'm not even close to being ready to take on my own patients.

During your orientation at some point has your preceptor allowed you to take some of the patients from the team you guys are working with? My preceptor the first day let me shadow her.Then the next day I got 1 of our five patients and she got the others.Then the next day it was 2 and so on.She was still there,but I guess she's trying to slowly get me into feeling comfortable with having my own patients.By doing this you start trying to get a routine down.With being on the cardiac some of the patients are really complicated cases and she does help me. Often I feel overwhelmed, but I know I can always ask for help.I would rather ask to many questions and seem annoying vs not asking and risk making mistakes.

Pachinko · Dec 2, 2006

Yep, I also feel incompetent. It's been said many times before on many different threads, but nursing school so does not prepare you for the reality of being a nurse. And I'm relatively lucky--I work in a med-surg unit with a typical patient load of one-to-four, though the patients can be very sick. My preceptor's been good but very demanding, and I sometimes come home feeling like I'm never going to get it.

THEN I take a moment to look around and realize that the more experienced nurses, the ones who make it look relatively effortless, are not necessarily smarter or more skilled than I. They're just more experienced. The light at the end of my tunnel is being able to walk onto my unit some day--in a year? two years?--and feel like I can handle anything that's thrown my way. Getting there will be hell, but I know it will happen.

hica19 · Dec 2, 2006

Actually things have gotten better since I last posted. Two nights ago was my last night with a preceptor. I pretty much did everything on my own. My preceptor just sat around talking to people or surfing the internet. However she was always available if I ever needed help. I felt really good about myself. I put in an IV for the very first time as a RN, and I got it in on the first try! I've only had 2 other chances before, and that was when I was still a student. I got one in, and missed the other due to rolling veins. And in whatever way I don't know, I managed to really soften up an angry and demanding patient. First night, he was really angry and demanding in the beginning regarding his medications. Lots of expainations and teachings were done to him regarding one time dose medications and medications that were exchanges from the ones he takes at home. Later that night, he got much better. Next night I had him as a patient, he was not only compliant to me, he was actually quite friendly! Made me feel good. Next time I work, I'll be on my own and I'm starting to feel more comfortable with that. I know whatever I'm feeling is the typical feeling of a new grad.

amy0123, BSN, RN · Dec 3, 2006

THEN I take a moment to look around and realize that the more experienced nurses, the ones who make it look relatively effortless, are not necessarily smarter or more skilled than I. They're just more experienced. The light at the end of my tunnel is being able to walk onto my unit some day--in a year? two years?--and feel like I can handle anything that's thrown my way. Getting there will be hell, but I know it will happen.

WOW, I just thought of this last night during my shift!! I also thought about "hanging in there" on this unit. I looked around the room at the other nurses and continued thinking. I am out of orientation in 3 weeks. I don't know all the ropes nor are there guidelines. Experience, indeed would be the route to making this effortless. Just got to be careful as a newbie and ask for help PRN...

However when something does get thrown my way, big or little, I scream a silent "ow!" in my mind. Documenting, chart checks, MAR, progress notes, orders, labs, results of procedures must be known and completed well before meeting the patient. Then there are the meds that are due, the family/pain issues and phone call interruptions. This is all overwhelming due to time constraints. There's just not enough time to do it all!! :uhoh21:

Currently my life is all about working as a nurse. It is the biggest event that I have yet to feel competent about. I could spend a lot of time organizing myself preparing the "plan of care" for all 3-4 patients... Yet by hurrying myself, some small significant detail could be missed. Being new, this can be very devestating. :uhoh21:

Therefore I continue to walk through fire, reaching for that light at the end of the tunnel with both hands.

NYpedRN · Dec 5, 2006

first year is hard work. I agree. I was feeling so incompetent when I started. I had never done procedures like this in my nursing school. In the hospital that I rotated in, the nurses never drew bloods, put catheters in, never did anyIV insertions, etc. This place is crazy. Every child I have has a broviac or some kind of central line. That means central line care, central line blood draws, 50% of them are on TPN. They are post -op liver trans, bowel trans, etc with mag and k runs and all kinds of heavy duty stuff. I never gave blood or blood products before I worked here. I never did any of that stuff. I was doing bed baths and the hardest part of my rotations was like...trach care and vents. Never did I imagine I would work at such a high acuity unit.

I thought I was going crazy when I realized that --who I am to complain that my work is hard? We have computerized charting, no paper! We hae 4 or 5 pts, we don't draw peripheral bloods, and we don't insert IV's unless IV certified.

So, I trade in good for bad. I was going to transfer to another hospital with a less intense unit but - go back to paper charting, more pts, less nurses, less pay...hmmm...trade for trade, the bottom line is, it's going to be hard the first year in nursing no matter where you are. Sometimes I just feel like I'm going crazy, but other days I feel blessed.

Good luck to everyone!

mssensitivity · Sep 13, 2010

I graduated in Dec.09 and came off of Orientaton in May. I have been having good days and then bad days throughout this time. I work on a Geriatric MedSurg/Stroke/Vascular unit. Well, for the past 3 weeks, its as if the bottom fell out from underneath me. Prior to this my days have been very busy, end up staying late and working my butt off, but my patients love me, I have gotten many recognition letters from my patients that go to the manager and we get complimentary lunches for a "good Job". then, things went haywire. My patient assignments were off the roof: 3/4 patients being isolation, 2 patients on restraints with severe brain damage from CVA's and a another rather large patient on dialysis, sepsis, pressure ulcers. The acuity of my patient assignments were like this for the past 3 weeks if not worse, with last week me being given 5 patients, all of whom were on isolation and very sickly requiring multi interventions.

I have been asking for help; like a mentor, someone I can go to and discuss my caseloads and the goings on of the day at the end of the day, and even throughout the day; like a mentor that I can go to during my shift to help me with questions regarding the patient illness, how to do this or how to do that, confirm my observations and or how they would have handled the situation. how would you handle the priority, document, etc. Last week I had a preceptor follow me, and needless to say, it was difficult, my assessment documentation wasn't completed in a timely manner, it was if having her be with me threw me off completely. I didn't know she was going to be with me and I guess this is what caused me to sink.

Long story short, on Thursday, my manager told me there would be a discussion at 1400 to discuss observations the preceptor had noted. Well I go into the office and not only was it the manager, my preceptor but the nurse educator from the hospital, whom I value her opinion. It was three against one (this is how I felt by the end of the meeting)

Much have had to been said about my performance for three of them to be there; and when I stepped into the office, I said "hmmm this looks more serious than I had expected." No comments wer made. Long story short, I felt as though it was 3 to one, I was backed into a corner and felt speechless, I'm not a good one who can just have things roll out of my mouth and defend myself, when it comes to responding to comments made. I do as an afterthought.

My preceptor said that I was very disorganized, I don't assess my patients for pain; and there was an issue 3 weeks ago regarding heparin that made me "an unsafe nurse" 3 weeks ago I had a patient given to me in report, who was an ortho patient. The dr. had him on 600units/hour = 12 ml/hr. This wasn't low dose or weight dose. It was heparin, so I guess cause I didn't understand what sort of heparin this was and didn't look at it well I look stupid. I have worked with heparin about 3 times now since working on the floor, but it is not consistently. Very spread out.

The night shift passed to me this patient, and she had one IV access line for heparin, a banana bag, NS and an antibiotic. She was running everthing though this one line at a time (except for NS), and I questioned this, but she said "oh no you don't need more than one line, you just piggy back these meds through the heparin. Now, my gut told me that I didn't think this sounded correctly, but I didn't question her b/c she is a seasoned nurse, and maybe I was just missing something that I had learned and I would research later. The heparin order later this morning was changed to a low-dose protocol order; and this is when I sought out help. I was told that this makes me a nurse that is not safe, b/c my gut told me something wasn't right, and I should have sought out help immediately. I feel horrible. As far as the Assessment of pain, I did deny this 100% b/c I do this often throughout the day; my preceptor based this on one family members comment whom happened to be a physician, and who came in to see her mother at the change of shift. Since the preceptor was in there talking to the family, I felt confient that the preceptor was taking care of the family since I had to give report and complete additional interventions with other patients. Well, this backfired on me too. I did explain my side of the story and was very confident when I explained my rationale of the whole situation.

I was reprimanded about the heparin and basically told that by me allowing this medication to hang the way it was, was unsafe, and this is why I wasn't a safe nurse. I was told heparin, is heparin, is heparin, and when the new order came for "low-dose protocol" I could have just changed the rate, and sought out help to double check my math. but I think this is wrong too cause you have low dose and the weighted, right?

In this meeting was told I was a very disorganized, unsafe and a nurse who does not assess her patients for pain in a timely manner. I did attest to this and the organization skills b/c I believe in myself as being very good at this, but as with anyone else improvement is always a given for all of us. Wow, do you want to talk about low self esteem and feelings of stupidity? I'm at the bottom and haven't slept all weekend, and have a nauseated stomach...etc.

Can I get some advise, please, can someone give me insight to my disarray, have I even gave enough information to get sound advice? I hope that this letter makes sense and I can get advice. Should I stay at this hospital or should I leave?