"Two-yearitis"

  1. 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.
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    About Ruby Vee, BSN, RN

    Joined: Jun '02; Posts: 14,123; Likes: 59,007

    27 Comments

  3. by   firstinfamily
    Guess I am one of the "crusty old bats!" My motto throughout my nursing career has been "when you know it all, you need to find a new career" With the dynamics of nursing and the medical field there is no way anyone can know it all. We work in a very dynamic field that is always coming up with "improved" methods, research, to help make our care better. Now, I must admit some of the computer mumbo jumbo has gotten me down, but usually the bedside improvements have encouraged or enlightened me!! I always felt it takes anyone at least 5 years for them to feel even remotely comfortable in their position. I do not always agree with assigning 2 year nurses with charge or preceptor duties, I don't think they are truly ready. They may have a little bit of a swollen head thinking that they are. I know I certainly was not ready in 2 years to assume such duties. Is there a clinical ladder progression in your facility?? Is it a "click/group" of nurses who started at the same time and suddenly feel it is time for them to move on because new grads are present and they feel threatened?? I truly do not feel any nurse should be "comfortable" in their position. There is always something new to learn, something to change the old routine, and challenges on how to improve what we do to avoid the comfortable position!!! Some of the nurses who progress early in their careers are the ones who burn out early!! You might suggest to them they need to slow down a little to remain viable. I see you have 38 years of experience, so you have seen nurses, procedures, come and go. Ah, it is so nice to be a "seasoned" nurse and not get all wrapped up in what the younger ones consider imperative!!! Does it upset you to see them move along the career ladder at a fast pace?? It will be their downfall when it happens, and unfortunately they might affect how a patient recovers along the way.
  4. by   wannabecnl
    Timely post! I have been pondering this 2-year mark as I just passed it a couple of weeks ago in PACU (went in as a per diem new grad), and I have a few things to add.

    First, I may be the exception to your rule, because I am anything but overconfident. In fact, I get frustrated with myself (and the docs get frustrated with me, too) because I feel like I'm still asking too many questions. The other day a nurse "excused" me from helping with another patient because I needed to get mine transferred, and it reminded me what an albatross I still am. The nurse came back to talk to me later and said when she was starting, it took almost 5 years (like you said) for her to not feel that way. I don't resent that people feel this way about me, because I know it is true; I'm still a drain on the system, and I don't want to be! Seems like I "should be better" than this by now. I'm too old to go off half-cocked to look more competent, but the alternative is to be underconfident and slow. Safer, but still problematic.

    Second, 2 years is a weird place. I'm not a new grad anymore; I now have too much experience to take a new grad or residency type position in any department. However, do I have enough experience to do anything else? Doesn't feel like it.

    Third, the good part: there are little moments when I know I'm getting there, like making a good call on not giving a PRN med, catching an incorrect med order before the patient went to the floor, or having a good reason why my patient is still in PACU after 2 hours and not having the charge nurse tell me to throw them out! Those moments come closer together these days, and the number of patients I can just take, recover, and transfer without fanfare is growing.

    I will keep your words in mind. One of my wisest colleagues once said that the day she didn't learn anything new would be the day she retired. She did retire this summer; I had suspected she in fact knew everything...
  5. by   No Stars In My Eyes
    It sure is true you can learn something new every day, and from anyone!! I learned two of the handy-dandiest time-saving tips from a CNA during my 40th year in the field.I never would have thought of them on my own and now I use them almost daily! I have been taught to do things by family members of my patients when I was in Home Health. And I'm never ashamed to ask questions about anything if I'm not clear about it. There's nothing stupid about asking for clarity.
    I've been whispered about behind my back and had to 'suffer' the eye-rollings of younger nurses; but I just think 'Pppfffttt! You just wait; your day will come.' Doing a face-plant can be embarrassing to the ego, but harm a patient through your know-it-all, stubborn ignorance and it is something that you will carry with you all the rest of your days.
    To those arrogant little employees, I say: Better to be thought stupid than open your mouth and prove it!
  6. by   sourapril
    The two year thing maybe true, maybe not. I am not against anyone who like to show their confidence, as long as they don't put patients in danger or their coworkers in misery. I think it depends on individual person's personality rather than number of years as a nurse. I can't stand those two-yearer who are snobs, I also can't stand those nurses who greet you with "I have 30, 40, 50 years of experience in nursing." My response to the latter is usually "so why are you still in the same job?"
  7. by   firstlight
    I saw this trend many years ago. I learn something new every day whether its reading, classes or talking with other nurses/physicians.
    How can you not?
    I have always wondered why they are in a rush to do it all so new. Two years is pretty new to me.
    You need time to learn, time to obtain wisdom and time to build inner strength for all the stresses of the job.
  8. by   TeflonNurse
    Quote from No Stars In My Eyes
    It sure is true you can learn something new every day, and from anyone!! I learned two of the handy-dandiest time-saving tips from a CNA during my 40th year in the field.I never would have thought of them on my own and now I use them almost daily!
    Now wait a minute! You can't just leave us hangin', what are the 2 handy-dandy tips ;-)
  9. by   Lev <3
    I will be approaching the two year mark in a couple months. While I do favor the increased confidence and knowhow I still have plenty to learn. And I know I was asked to precept a nursing student after less than one year on this particular floor not because I would do it better than my colleagues but because my boss sees "potential" in me. My student has plenty of questions I don't know the answer to, but I have no problem pulling out my phone and looking it up.
  10. by   No Stars In My Eyes
    Quote from TeflonNurse
    Now wait a minute! You can't just leave us hangin', what are the 2 handy-dandy tips ;-)
    Well, now, neither of them have to do with rocket science, and many of y'all probably already know them.
    One has to do with holding or restraining a spit-fire, ambulatory little oldster without causing bruises or skin tears, and that is to place your inner elbows under their armpits from behind and holding them close that way. They can't reach you to hit or scratch or bite and you don't have to have so much strength , only enough endurance to hold on 'til help arrives. It doesn't necessarily work as well if you are smaller than the patient, though. And I DO have a spitfire pt. who likes to jump up and take off screaming, "Help! HELP!" She's not too steady but she doesn't seem to realize that, so trying to RUN away is dangerous for her.

    The other has to do with changing pull-up briefs without having to remove the pt's pants/shoes; just feed the clean briefs down each pant-leg one at a time,around the foot and up the leg. Takes half the time and a lot easier than undressing and re-dressing the pt. again.

    Since I do PDN and much of it consists of ADL's more than technical stuff, I was tickled pink to learn a new way to take care of an old problem.
    You're probably saying 'meh', but, oh well!
  11. by   sandyfeet
    I am in your target demographic; I just passed 2 years this summer. I am starting to get more involved by doing clinical ladder. The people I started with (also mostly new grads) are starting to do Triage because of a shortage of triage nurses on night shift, and people on day shift have complained that they are too new to take on such a task. I can see where the complaints are coming from because I don't feel ready to take on the responsibility of a full lobby!

    I will say that I thought I would know more by now and I've learned that knowledge is just a slow, steady process. And that sometimes I need to hear something several times to understand it, just like in nursing school.
  12. by   Despareux
    I'm at two years and yes, my confidence is high, even higher than some seasoned nurses. I'm still asking questions and looking for feedback from my fellow nurses; thankfully, I have enough confidence to do so. I also have enough confidence to ask for more training in areas where I know I fall shortest. I'm always looking for ways to improve my practice. One of the reasons I went into nursing is because the learning never stops and for someone who has a very thirsty brain, nursing simply fits that bill. With all that said, I admit that I am game for something a little more challenging, which is why I'd like to work day shift. On days, you really have to know your patient in a very short amount of time to be able to answer questions from families and at least five different specialists at any given time.

    In the two years working on my floor, I've come across one "overly-confident" new nurse who also seemed very lazy. I don't know if she was truly over-confident or if she just simply didn't have the confidence to ask any one of us for feedback or whatever, but she made some questionable decisions with disastrous outcomes. I'm glad she's not on our floor anymore. I work with a very supportive and knowledgeable team of nurses and NAs on nights; we are not mind readers and if you say no thanks to our unsolicited help or advice, then we assume you got it under control.
  13. by   Emergent
    How about 3 month, smartie-pantitis? You know, the newbie with an inflated sense of self-esteem and the unparalleled ability to toot his/her own horn in self adulation.

    We have one in our unit at the moment; Such a genius We are all in amazement (At how self congratulatory one guy can be) Why, he now even has a sentinel event under his belt (he s a real hardened veteran )
  14. by   Racer15
    As a nurse with 2 years under her belt, it kind of frightens me when I hear two new nurses discussing something and end it with "ask Racer15, she'll know!!" Now sometimes I do. Moderate sedation, placing central lines, general medication questions ...sure thing. And I enjoy helping and teaching the new nurses. I don't know why a nurse with only two years under their belt would be mean. I work in the ER, which is where I started out. New grads need support and encouragment. Sure, call them out when they make a big mistake but they are new, they'll ask dumb questions, make mistakes, and be better nurses for it.

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