Having confidence issues in clinical rotation

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Specializes in Critical Care.

Hi all,

I have just started my ACNP clinical rotation and I often feel as if I know nothing. Prior to starting the program, I worked in the SICU for 6 years and in a tele unit for 3 years before that. I was a resource on my unit as an RN and I felt confident in my abilities as an ICU nurse. In my ACNP clinical rotation, I feel like I don't know the answer to a lot of the questions they ask plus my nerves play a huge part in making my brain not work. Even in the SIM lab, I feel like I freeze up and am not able to think quickly on my feet. As an RN, I was always running the codes. I used to get tons of compliments on how well I ran codes. Very calm and collected. I have expressed my feelings to my best friend and husband who are both nurses. They both state that this is all normal and they know how smart I am and that I will be fine. I just don't always feel like I will be fine. I feel more like I am one of the "dumb" students.

Is this a normal feeling? I know that if I felt more confident, I would probably perform better in clinical. Any advice? Suggestions? words of support? These would all be appreciated.

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Specializes in FNP-C.

I had the same issue! I felt the same way. I'm nearly done with my FNP program and I'm getting used to the role and the "need to know it all" mindset. As an RN, many things didn't really matter so much if you know what i'm saying...just as long the patient stayed alive and well in the hospital and got discharged...and that the physician didn't miss anything...

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

It's natural for people to feel inadequate and lose confidence when you venture into unfamilar territory. Nursing and medicine are intertwined in the hospital setting but few nurses realize how different the mindset set is for the two professions until you cross over to the other side with only your nursing background to fall back on. There's definitely a whole new knowledge base to be attained and in such a short period of time because of the pace and length of our program. I remember some ICU nurses being so easy to pick on residents and even fellows about their decisions regarding treatment and yet being placed in the same predicament now as a provider, I see how it can be difficult to weigh the risks and benfits of a treatment you carry the full responsibility for in terms of outcome.

During my rotations, I actually felt the same way as you do now. In my ICU rotation, I was fortunate to have a resident and a fellow in the team who were very helpful in teaching me when I had questions. They actualy took a lot of heat during rounds because they were constantly being put on the spot by the attending. My Cardiology rotation was with an experienced NP who is very smart and I tried to ask as much questions as I could when we're not busy. I think the key is to take in as much knowledge as you can because the program pace is fast given the short period of time to complete the courses. I read a lot and even used internet resources such Up To Date and PubMed in the clinical setting prior to rounds to prepare my patient presentations. I always had what we formerly called a PDA and had all sorts of what we now call medical apps on it.

Good luck and it will get better as you move along.

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Specializes in Peds Urology,primary care, hem/onc.

Totally normal!!! It is a hard adjustment to make to go from being an expert in your field to going back and feeling like you know nothing. To me it was a harder adjustment then when I was a new nurse. Relax and do not be so hard on yourself. It will take a year until you feel comfortable again. If you felt like an expert while you were in school that would worry me just as a new grad RN who believes they know it all is a worry. it will get better. Study hard and absorb all of the new knowledge! You will be fine!

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Specializes in Critical Care.

Thank you all for the support. To know that others felt this way is a huge relief. I am feeling better about everything today after reading your comments and talking to my husband. He pretty much gave me the same advice. I am going to embrace this as the learning experience that it is meant to be and try to absorb as much knowledge as I can :)

Thanks!

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Specializes in Med-Surg, Telemetry, CCU, ER.

I am in an ACNP program also and at our clinical orientation, we were told, be prepared to be feeling unprepared and dumb for the next year. She said, you are expert nurses but novice NP's and you are going to feel very unsure and that is normal. So hang in there.

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I'm an FNP but I have to agree with the others....if you don't feel "dumb" at least a third of the time then you are too confident and actually almost dangerous. Throughout my program, we had one or two students who acted like they knew it all. One of those students failed his certification exam repeatedly. Also, this is the time most of us ate our former words...you know, when you would say you knew as much as a Dr. and you could do X and X and X. It is WAY different to interpret the data and call the shots when you have the provider role to back it up.

A friend of mine in the ACNP program felt the way you do but continued to feel that way almost through her last year. She finally realized that she no longer cared for the "rush" of the critical environment and found a much better fit in the FNP program. You may at some point find that you don't like being "on edge" all the time in a critical environment.

Nursing and medicine are intertwined in the hospital setting but few nurses realize how different the mindset set is for the two professions until you cross over to the other side with only your nursing background to fall back on.

This is why FNP students without specific advanced training in the hospital setting DO NOT belong there. Critical care nursing experience is not enough.

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Specializes in cardiac.

I'm in my second to last semester in my ACNP program and I could have written your post myself! I consider myself "book smart" but I have the same confidence issues and freezing when asked a question on the spot! I know the information is in there, I just also get very nervous.

I've been blaming this on never working as an "ICU nurse" and feeling like I should have done that before this program. So I'm glad to hear you feel the same way! I have this paranoia that nurses (especially ICU nurses) think that I think I'm "better than them". I know I don't act this way. And I know that they know much more than me about many things and I'll be using them as resources for quite a while. I just keep asking questions and trying to learn :)

As others have said, we'd be dangerous if we weren't this way. Of course we don't know everything yet (and never will)! My instructors have told me that feeling this way mean I'm really learning. I keep complaining that the more I learn, the more I realize I don't know! I keep having to remind myself that it's a good sign.

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Specializes in Critical Care.

@ carachel2- Thanks for the encouragement. I have a few of those students in my class too...they drive me crazy :) I do understand how the stress of "being on the edge" can get to be too much. I enjoy the ICU environment and really like the diagnosing and figuring out what is going on with the patient. I just feel like I am still having trouble putting the pieces together sometimes, but when I do get it, it is a great feeling. I have always had respect for the MDs I have worked with in the ICU but this experience has given me a new perspective. I understand their actions SOOO much more than I did before.

@ cardiojenny - thank you for your comments. It is comforting to know that others have felt the same and turned out to be okay. lol. My ICU experience is definitely an advantage but it is also no help in certain situations. My background was SICU and I always knew that different units did things differently but I am beginning to understand the extent of this. I can treat a septic patient with my eyes closed but cardiogenic shock... that is still something I need to really think out in my head. I just haven't had much experience with those types of patients. I can really relate to "the more I learn, the more I realize I don't know." -- that rings so true. BTW, where are you working now that you graduated?

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Specializes in cardiac.

I don't graduate until August...thank god!!! I'm not ready to be out there yet. Not sure yet what I want to do, there are so many options! I've been thinking cardiology all along, but probably because it's my comfort zone. I'm afraid to specialize right out of the gate and forget all the other stuff I learned. A hospitalist position I think would be fun and interesting. I talked to a NP I know the other day and she told me I'll leave a little trail behind me of all the things I learned but don't use! I guess it will really depend on what jobs are out there too!

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Specializes in Critical Care.

I'm sorry, I misunderstood. I thought you had already graduated. Good luck with finishing up school. I have thought about a hospitalist position myself. I think I would like that but I would also like the an intensivist position. It is all up in the air though depending on what positions are available. I like the breadcrumbs analogy. It was like that in nursing school so I am sure NP will be no different.

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Specializes in Critical Care, Orthopedics, Hospitalists.

The worst part of NP school - feeling like a "new grad" again! I mean, really? We go through all that nursing school, start a job as a new grad, don't know nothing about nothing --> finally get good at being a nurse, then we go back to school and have to start all over! LOL - what were we all thinking? I can't wait to feel like I know what I'm doing again. ;)

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