How to stop feeling apologetic for my inexperience?

[splendid, BSN, DNP, RN, NP]

I graduated with my BSN in May 2013 and started working at a Critical Access Hospital (CAH) at the beginning of December. Because the hospital is so small, my orientation has consisted of working as an extra RN (usually there are 2 RNs and 1 LPN working) and learning as much as I can from the RNs and LPNs. I worked nights during my first month, then on days for the last 2 months. Just switching between the two shifts was a bit of a transition because they're quite different. As soon as I started understanding the basics of what the night shift staff does, I was put on day shift so I could "learn more." I almost felt like I was starting over when that happened.

During my orientation period (which is still ongoing but may only last a few more weeks...it's up in the air right now), I have been moving back and forth between the inpatient floor and the ED (they're adjacent to each other). Lately what typically happens is that I begin the day with doing inpatient assessments and focusing on what needs to be done there, but then as the ED picks up later in the day I take patients on that side (while trying to keep track of what's going on with the inpatients, because sometimes I'm asked to give report on them even when I haven't done much there during the second half of the shift).

Now I'm also being scheduled to help out in the OR recovery room (there are a handful of surgery days at the hospital each month). That is yet another new setting in which to learn as much as I can just by being pushed into doing with some explanation from the other RNs here and there. I'm thinking of asking to hold off on the recovery room days for a few months because I still have so much to learn in the inpatient/ED areas and adding one more area is another source of stress.

The nursing supervisor seems to be understanding and patient with me. Besides me, she is the only RN at the hospital who graduated from a BSN program and as a result she seems to be the only one who understands just how little clinical skills are focused on in a BSN program...the rest of the nursing staff doesn't really get it. They think it's a shame that someone could come out of a nursing program not knowing how to jump into working as a competent nurse. I see their point, but it's not exactly something I can change.

The nurses I work with have been helpful for the most part, but at the 3 month mark I feel like they're starting to get really impatient with me and expecting that I should know what I'm doing for the most part now. I've talked about this with some of them and they say that even after a year or 5 or 30 nurses still have moments of not being sure how to do things, and they tell me to keep asking questions rather than pretending I know how to do something, but I have a definite sense that people are starting to wonder why I'm not working more autonomously at this point.

The thing is, I can see that I've made tremendous progress in the 3 months I've been there. When I started, I didn't know how to hang IV fluids, note and carry out orders from the physicians, or what was used to clean/change over a room in the ED. It seems that I learn how to do new things every shift, and I've been feeling good that each time I go to work there's a little more that I can do on my own. Coming from a background of zero healthcare experience, I thought that I was doing fine for my experience level (basically none) and making slow but steady progress. (I also completed ACLS last week, and am planning on taking PALS soon.)

Yesterday, I was getting ready to leave when one of the two RNs I'd worked with caught me off guard in the break room and started telling me that I need to be confident, that I have no confidence and am timid, that I need to stop saying things in front of patients about not knowing how to do certain tasks, etc. After it was over I thanked her for the "pep talk" but it felt more like she was haranguing me.

It seems like my fellow nurses are continuing to say that they want me to ask questions, that they understand that I'm new and still learning, etc., but at times it now feels like they're impatient and that I'm an annoyance. This is what happened yesterday with that particular RN: she would be chatting with the other RN, and I'd keep having to interrupt them in order to ask a question about how to do something. At one point someone came into the ED with a cut to his hand, and the physician came in to fix it but then said "you haven't cleaned it yet?" I told him I'm new (he'd only worked there once previously and doesn't know me) and that I was going to do it right then and he was fine with that. Any nurse with experience would automatically know that you clean a lac before the provider comes in to repair it, but this hospital is tiny (we don't see nearly as much variety as bigger hospitals do) and I hadn't seen one like that before so didn't know what to do.

I asked this RN for help because I didn't know what to do and she helped but it seemed like she was also annoyed that I didn't know how to do something so incredibly simple. At that point I said something about how I know I look stupid right now but I just don't know what the procedure is for something like that and that I needed someone to show me one time so I can handle it in the future. I know I shouldn't have said it in front of the patient, but I let loose a bit because (a) I knew the pt was also licensed as an RN so I was being a bit more open than I should have, (b) my frustration level was at a high at the end of what had been a shift where some things went wrong, and © I had the sense throughout the day that this RN thinks I should know more at this point than I do and I was feeling emotionally exhausted by that.

Fast forward to the end of the shift when she's telling me I have no confidence, to NEVER say something like that again in front of a patient, that I'm timid, and that I'm smart and know what I'm doing so I should just be confident. She also stated that by this point I should know how to do a lot of things, and that I need to stop taking things so personally.

I left feeling terrible. I know myself and I know that my confidence--as an RN, and as a person--has been growing steadily as I've gained some experience. I know that it's going to take a year or two to feel like I have even a basic level of competence as an RN, and I'm okay with that. Yet when I'm at work there are times where I start apologizing left and right for not knowing things, because it feels like the only way to deflect people's judgements about me. It's not that I'm actually sorry for not knowing things or for asking questions; I'm fine with that. I end up apologizing and being self-deprecating as a way to let other nurses know that I recognize that I have a long way to go, in the hopes that it will keep them from thinking even less of me than they already do.

I know that's messed up and that I need to stop, but it's something I've been doing almost automatically lately.

I keep telling myself that competence is only going to come through experience, and that experience takes time. It's tough getting a variety of experience in the CAH setting because I might see something on one shift and then not see anything similar for months (a similar lac, say) or years (a birth, a chest tube, etc.). We just had a week go by in which there were NO inpatients--I didn't get much experience with inpatient care that week.

The bottom line is that I'm doing the best I can, and I can see myself growing in knowledge, skills, and confidence from shift to shift. My problem is that I've now started to apologize for asking questions and not knowing how to do things because I feel like the RNs and LPNs I work with are getting fed up with my inexperienced self. I truly don't believe that the answer here is to "be more confident": I think the issue is more one of competence and that that can only come with time.

In the meantime, how do I cope with the constant stress of feeling like my co-workers are saying that they know I have a lot to learn, yet are acting impatient with my questions, requests for help/guidance/instruction? How do I stop myself from apologizing for my inexperience as a way of letting everyone else know I'm painfully aware of it?

[Sun0408, ASN, RN]

More than 4 years in and I still ask questions !!! That is the right thing to do for your pts safety. Never apologize for that. I think in a few months you will look back on this "pep talk" and realize she/he was just helping you see you are moving forward and have learned a lot but you need to see that and believe in yourself at the same time staying safe.

I agree, don't say those types of things in front of your pts, it can make them distrust you. Ask questions away from them.

At only 3 months in, you are right where you should be. Don't be so hard on yourself and ask anytime you are not sure. Can you brush up on basic first aide, brush up on some skills/assessments related to your pt population etc... Ask yourself what you can do to get more exposure?? Offer help to those that help you out with questions. Watch others as much as possible, it is a great way to learn as well. Do you have access to your P&P manual?? Confidence will come with time. Hang in there :)

[LPN Guy]

Sometimes when you are in front of patients you have to be an actor of sorts. Act experienced and confident even if you don't feel that way. It will all come to you eventually. I would not worry so much about the patients as in my experience patients can be very wise and understanding. It's what you share with co-workers and staff that I would be guarded about. Watch what you share with fellow staff, and go by my own personal maxim at work - don't entirely trust anyone. Just my 2 cents based on working in a hospital for almost 8 years

[tokebi]

I understand why you end up automatically apologizing. You feel terrible for having to ask other nurses, and you feel like you need to say something to alleviate the uneasiness and tension. How about expressing your gratitude instead of apologizing? If I were the nurse showing you something, I would feel pretty good hearing a thank-you rather than an annoyingly profuse apology.

And please, stop worrying so much about what other nurses think of you. You're absolutely doing the right thing by asking for help when you don't know something. Everyday, you are learning more and more. Gradually you will be asking for help less and less. You are constantly progressing whatever you may think. Focus on learning and give yourself a pat on the shoulder whenever you learn something new, instead of worrying about inconveniencing your colleagues.