I've been reading some posts on allnurses.com lately that reveal a pattern I've noticed in my practice. The nurses who are the least approachable and the most overconfident seem to be two year nurses. Students and new grads complain that the two year nurses don't treat them very well, and as an older nurse I've noticed that sometimes they don't treat me very well, either. I'm not saying that this is true of all two year nurses, or even most. But it is true of many.
At two years, a nurse is just starting to become competent as a nurse and in their particular job. I know a lot of you out there feel you're competent after a much shorter period, and perhaps a few of you actually are. Very few. It takes about two years to learn to be a nurse, to learn your patient population and to be exposed to enough "unicorns and zebras" that you don't automatically discount the idea that the hoofbeats you hear might not actually be a horse. It takes about that long to start noticing the subtle changes that may herald a downward slide in your patient's condition, to refine your critical thinking skills and to perfect your time management. At about two years, some nurses are becoming senior on their units or are being asked to do charge or take on responsibility for precepting or co-chairing a committee. Two year nurses can be very good nurses -- IF they are also starting to realize how much they don't know. It's the two year nurse who is confident that they know everything who is dangerous, difficult to work with and demeaning to those they perceive as "less than" themselves. The "less than" would seem to fit students, new grads and anyone approaching retirement.
It's true of new grads that "they don't know what they don't know," but it can be equally true of two year nurses who are convinced that they MUST be terrific or they wouldn't be asked to precept or learn charge. Maybe it's just that the unit is desperate for preceptors with fifteen new grads coming on staff this quarter or that all of the charge nurses are on maternity leave or fleeing the bedside for "greener pastures." Maybe it's not that they're such great nurses NOW, but that the management team sees potential and is investing in their development. Perhaps they've always been trustworthy in that they won't do anything stupid without consulting someone with more experience, more education or more expertise -- and they've interpreted that trust incorrectly as being seen to know all they need to know.
The difficulty is that it's almost impossible to teach anyone anything when they're already convinced that they know everything. The two year nurse whose confidence exceeds their competence is a case of arrested development. They won't develop more as nurses until someone (or more likely someTHING) convinces them that they don't know as much as they think they do. Sometimes that someTHING can be detrimental to a patient. Or to the new grad they're precepting who carries wrong information forward in THEIR practice. Or to the unit as a whole . . . arrogant two year nurses are tough on morale. Crusty old bats can take it; new grads can't.
Everyone -- even someone who is nearing retirement -- can learn something new every day. And we can learn it from anyone -- even students and new grads. If you keep that firmly in the forefront of your mind, you just might become that great nurse someday.
