Feeling incompetent

aimeee, BSN, RN · May 28, 2002

Hang in there, kiddo! The fact that you are loving the patient care and working with the elderly is the important thing. Floating from unit to unit only on weekends is a tough way to re-enter though. I think your comfort level would go up much faster if you could work the same unit every weekend. You would get to know your residents and their needs and be better able to organize yourself. ASK for this...tell them you feel you will be better able to take care of the residents if you have a chance to get to know them and their needs well. They may or may not be receptive to this but you won't know until you ask.

When I first began nursing I went straight to LTC. I have always worked part-time (3 days/wk) and floated between 4 different units. I felt just like you do now! One of the 4 units was skilled care and by the time I floated back to it usually half of the patients were new to me. Eventually they asked me to work solely on the skilled unit so they would have more continuity, and although this meant working the most difficult unit, I found I actually preferred it because I could finally begin to get into a groove.

One of the things I used to do to help organize myself was make a chart before the shift began. I listed all the room #'s, patient name, had a column for BS where I put the time in if they needed a glucoscan and also wrote their BS in there after I checked it, a DNR column where I checked off all the residents who were DNR, a dressing/treatment column where I noted the time for all dressings or treatments I had to remember to do, and a big box for writing important notes about a residents condition.

When I first began the shift I did a quick round, noting residents position with a U for up, L for left side, R for right, B for back...then as I was making the first med pass I could easily see which residents had been turned and attended to by the CNA's. As you know, when you are harried doing your own job it is really difficult to supervise others. Any time you make a trip up and down the hall you can carry your chart with you and quickly update it. It becomes apparent who is doing their work and who isn't and you have EVIDENCE to back yourself up.

If your med books don't have the nice pull tabs for flagging then you can easily make your own flags by cutting out strips of construction paper. One of our nurses got a little electronic timer she called her "brain" that she would set when she was running nebulizer treatments to remind her when it was time to go back and turn it off.

Comeraderie is nice, but sometimes it is there, and sometimes it isn't. If your facility is anything like where I worked, the mix is in constant flux so hopefully that will get better with time. If your coworkers are actually hostile, then look for another opportunity. Life is too short to work with nasties.

As you get back into the swing of things, I'm betting you will feel more and more confident of your critical thinking abilities. Its tough to do critical thinking when you are feeling harried and overwhelmed. Meanwhile, do your homework...spend a few minutes each day reviewing one specific skill or condition. Little by little things will begin to gel together and one day you will suddenly realize you feel confident and in control again.

kdhnursern · May 29, 2002

Whatever you do, don't give up. I think aimeee had the right idea, if you could work one unit most of the time instead of floating. When you float, you never really know the residents and their routines.

In LTC, the orientation is mostly lacking. As soon as a nurse shows she/he can pass meds and do the treatments, it's YOYO time (You're On Your Own). In my facility, we don't have a lot of IVs to start and we haven't had a vent in years. So most of the time, that sort of thing doesn't show up in the orientation period. The way we figure it, when something comes up that is out of the ordinary, it's a teaching opportunity. Find out who can do the best job and have them teach the ones who are rusty. It takes a long time to learn all that's needed.

Just don't be afraid to say "Hey, it's been a few years since I did this procedure. Can someone show me the way the facility wants it done?" Who knows, you might make a friend from someone who wants to mentor you.

ComicRN · May 29, 2002

I think Aimee and kd said most of what there is to say. I would also add that in you "spare time" familiarize yourself with your facilitiy's policy and procedure book. I'm sure it's about 3 million pages long (as most of them are). But, even just skimming through it and getting a general idea of how your facility likes things done is a good idea.

I've been an RN for 10 years, but there are many procedures I haven't done in a while. If I had to change a trach, for instance, I would have to call in someone to help me. No one knows EVERYTHING (although I'm sure there is at least one nurse in each facility who thinks he/she does!!) and there is no shame in asking for help.

Good luck and welcome back to LTC. :roll

lindalee · May 29, 2002

My son is now 30 years old. The only time I did not work full time in nursing was the first three years after his birth. I had practiced nursing for about 7 years before he was born. Let me tell you that after that three year lapse in practice I was scared to death! I took a refresher course--probably much to the instructors amazement. Yes, I was the only one out of practice for that short a time, but it did help me. It took about six weeks working full time to really feel I was back in the grove to practice safely. Hang in there, you will do just fine. Equipment and faces change but the basic principles are the same. You will get comfortable again, give yourself time. Welcome back. We need you.

AnotherRN · May 29, 2002

Thank you everyone for your words of encouragement, and practical ideas. When I was off these past years, I didn't realize how it would affect my skills and confidence level. I don't regret it as my children are my priority though.

You are right about the orientation. I was basically thrown on the floor running. Orientation pretty much consisted of "here is the paperwork, meds and supplies."

I love that I have found this board and others who enjoy working with geriatrics. When most people ask what I do and find out that I work in L.T.C. the first words out of their mouth is "oh I could never do that."

Blessings

nightingale, RN · May 29, 2002

You are on the right path... Try writing out some positive affirmations for yourself and read them everytime you start to feel low; fill your head with positve statements about how well you are progressing. A journal may help so you can see your progress.

((((((AnotherRN))))))) We are here for you!

B

live4today, RN · May 29, 2002

originally posted by anotherrn
i am very new to this forum. here is a little bit of background. i have been an r.n. for 11 years. most of this has been in ltc. i didn't work for 3.5 years to be with my young children. when i worked before it was because i "had to". i was very burnt out and frustrated. i'm not sure if it was because i was working when i didn't want to, or if i was burnt out by nursing. anyway, in the years i was off i didn't try to keep up with journals, or nursing in anyway. ceu's are not required in my state. i told my dh on a regular basis i never wanted to go back.

about a year ago i started missing ltc and went back to work on 3-11 weekends in march of '02. i absolutely love working with the elderly. i am enjoying the pt care like i never did before.

however i feel very incompetent. some of my skills are rusty. i have no confidence in my decision making/ critical thinking skills. i float to whichever unit they need me on. there are usually 25-30 residents. staffing is myself and 1.5-2 cnas. i usually pass all of my own meds and do all of my own treatments. i am having trouble getting everything done. also, i feel disorganized and harried. i also feel like i have forgotten basic knowledge and am rusty on crucial procedures. i'm not sure i could easily start an i.v. right now since it has been so long, and not something i routinely did in the past.

the nurses at this facility make a big deal about who is an r.n. and who isn't. also, i don't feel much comradarie among the nurses. i feel like my job performance isn't living up to my title.

if it wasn't for the residents i would hang up my stethescope now. should i keep studying the nursing journals and doing what i can to "brush up"? should i forget it and quit? are my fears legit, or am i just feeling insecure?

thanks for reading this long post. i haven't talked to anyone else about this for fear of being judged.

hello anotherrn! i'm an rn in the same boat as you as are many nurses returning to the field today who have been 'rusty' for awhile. i plan to return to nursing in the coming year, but not without taking a rn-refresher course. perhaps you would like to consider investing in one to update your skills and confidence level. yes, once a nurse always a nurse, but nothing ever stays the same. i bet you'd feel a lot better after completing a rn-refresher course. you can inquire about one at your local community college in their continuing education department. the courses are about 2 to 3 months in length. hang in there! i once worked ltc for two weeks before quitting, and that was when i worked steady as a nurse. i loved the residents, but it was difficult for me as a rn to 'blend in' with the predominantly lpn staff at that particular facility. this is not the case at every ltc facility i'm sure, but in my case it was. don't be so hard on yourself. go for the refresher course, and best of everything to you! (((hugs))) and :kiss

Fran-RN · Jun 3, 2002

AnotherRN, don't give up. As Aimee said, you need a plan for your day. I have done the same sort of thing at several different facilities and it really helps keep you focused. I also try to do organization type work when we aren't as busy, so that when we are busy, we can find things. ie, filling out ID data on lab requisition slips on all the residents and keeping master copies. If you are crushed for time on lab days this can save your sanity. I also had to learn to attend to my duties first and let the CNAs handle theirs. I found that I was doing a lot of their work then couldn't get mine done! Of course I always help them if they need help but no one else can do the things I'm responsible for. Right now I am blessed with a good CNA crew. Good luck. Keep smiling, it makes people wonder what you're up to.

micro, RN · Jun 4, 2002

hey, not that i need to post as those above said all so eloquently.......

but just to say.....good for you for your sake and your residents and patients sake for returning to nursing.......

yes, things have changed and you will build up your confidence in your "rusty no longer" skills.......

but never and i mean never lose confidence in yourself.........

those who love to be part of the problem, will always be part of the problem.......

i would love to work with you anyday.........

and if you ever think you are alone, you are not.....we have all felt the way you feel.....not just being new grads or student days, but at many times or periods in our nursing careers.........

love you

sandigapeachlpn · Jun 5, 2002

i have been at our facility for 4 years as of july. it's funny because i felt like a fish out of water after being in a doctor's office, and before that a floor nurse. i had a really difficult time too, with judgement calls and had very little confidence in myself. i was used to having a charge nurse or a doctor tell me what to do in any tough situation. now i am charge over night shift and i call the tough situations. please don't feel inadequate. if you like ltc then stick with it. if there is something you are rusty at, then find somene and ask them to walk you through it. i have good diagnostic, assessment and administrative judgement, and my real weakness is emergencies. one of the things that i do is rely heavily on one of the nurses that i work with frequently that has had years in the er. i tell her that i need her expertise from time to time and it makes her feel proud , on the other hand she gets flabbergasted with policies and staffing, those are my strong points. i have been a nurse for 7 years and i will never feel inferior for asking for advice or putting two or three heads together when i am whipped and frustrated. one thing i have learned and that is you have to have a routine in ltc. do you have mars that you can pull out to the left and right? i flag my mar pages out to the left for my meds, and my treatments to the right. when everything is back in the middle at the end of shift i know that i did it all. i hope this helps. i would love to work with you too, because i have been there.

fets99 · Jun 5, 2002

I am presently on mat leave. Going back to work in Sept. I am worried and nervous and I've been nursing for 10 years with an added 4 years as a CNA in the same facility. Times are changing in LTC. You are expected to be 20 places at one time, supervise junior staff and know all and be all. Somewhere in there you find time to care for very ill, fragile patients and try to keep family posted as well as docs, etc. My motto: Knowledge is power. Read all you can. Is there a senior nurse who you can use as a mentor? I remember when I started out this was a lifesaver. I told her years later what a role model she was for me... she never knew. I drew on her strength and confidence and it shaped the type of nurse I am today. Feeling rusty is normal and ok. Give yourself a pat on the back for all you do.