How long did it take you to feel confident as a nurse?

[future_nurse_d]

Hi everyone,

I am a nursing student about to start my last semester of school. I work as an Nurse Extern as well.

I have heard that, generally, it takes about a year before I will feel confident as a nurse. How long did it take you to feel competent and confident?

I worked yesterday and learned a few new things. I learned yesterday that you can't dilute diazepam in a NS syringe for an IVP because it precipitates. Can you flush the extension tubing with NS before giving the diazepam and then flush again behind it without worry, or is it best to just remove the tubing and push the diazepam straight into the hub of the catheter? Do they generally just like to avoid giving diazepam IV for this reason? So many questions! I love learning! Nursing school hasn't taught me this. Lol.

I also learned that a patient who goes into a short run of vtach can be started on O2 and then given magnesium IVPB. Pretty cool.

So I guess my questions are...how long did it take you to feel confident? How did you learn all the intricacies of compatibility/incompatibility and are there any resources for this? I have the epocrates app but it didn't say squat about diazepam and NS when I tried to look it up...do you think my Extern experience will help me at all when I become an RN?

thanks y'all!

[AliNajaCat]

Old, old news: Anesth Prog. 1978 Sep-Oct; 25(5): 158–160.

PMCID: PMC2516026

[h=1]Solubility of Injectable Valium in Intravenous Solutions[/h]Marvin F. Grower, Emery A. Russell, Jr., and Lee Getter "A study of the solubility of Valium in commonly used intravenous solutions showed Valium to be equally insoluble in 5% dextrose in normal saline, 5% dextrose in water, normal saline, and Ringer's lactate. However, the precipitate which was formed became completely resuspended when mixed with as little as 39-42% plasma in vitro. This would indicate that the chalky precipitate seen in the I. V. tubing when Valium is injected into a running I. V. near the venipuncture site becomes resuspended when mixed with plasma in vivo. If one elects to inject Valium into the tubing of a running I. V., it is recommended that the drug be administered slowly to assure adequate mixing with blood plasma in order to prevent the circulation of particulate matter."

Magnesium isn't the be-all, end-all for all short runs of VT; did you ask why it was best for THIS patient?

Keep asking questions. No knowledge is wasted, so you will learn things as an extern. As for feeling like a competent RN, that varies, but generally speaking it would be asking for trouble to expect to feel competent at less than 15-18 months, and four years is more like it. :)

[Horseshoe, BSN, RN]

It took me at least a year or two to feel "confident." The first year I felt literally sick to my stomach on the way to work every day.

[SopranoKris, MSN, RN, NP]

It takes about a year to feel confident on your particular unit. I transferred from doing a year of step down to the ICU after a year. Now I'm back to feeling like a brand new nurse again. There is a STEEP learning curve in the ICU. So much to learn (pressors, art lines, rapid infusers, CRRT, balloon pumps, etc.) I've been in the ICU for almost 6 months now and I'm just starting to feel like I'm getting my footing. There is still so much to learn. Our unit has a policy that we can't take open hearts or CRRT patients until we've been an ICU nurse for 2 years. I end up getting the "easier" patients on the floor, so some nights I have a lot of free time on my hands. I use that time to try to help out the other nurses with the high acuity patients so I can learn from them.

As a brand new nurse, it's going to feel overwhelming at first when you go from being a student nurse with 2 patients to having a full load of 4 or 5 patients. You're going to feel like you don't know what to do and how to manage. The first time you give report will probably be "wrong" compared to the way the seasoned nurses on your unit do it. Just make sure you don't ramble during report. Give the pertinent info, review of systems, etc. I found it very helpful to use a "brain sheet" that organized all my info so I could give report concisely. The brain sheet also had a 12 hour grid on it so I could make note of tasks that needed to be accomplished at a particular time (e.g. meds, lab draws, turns, etc.)

Listen & learn from the experienced nurses on your unit. You'll quickly find out which ones like to help out newbies, the natural teachers on the floor. Don't have a know-it-all attitude and be open to learning how to perform skills the way your hospital procedure dictates and not the way you learned it in school. You'll be surprised at some of the differences in what you learned and how the "real world" operates.

Try to relax and not to be too nervous. Patients and their families can tell when you don't have confidence in what you're doing. Don't freak out if you get chewed out by a doctor when you have to call to report a critical lab value or a change in patient status. It will happen, there are doctors who are just not nice out there. It makes you appreciate the ones who are caring & kind. Your nursing crew will usually have your back if they know you're going to have to call a doc with a reputation for being rude on the phone.

Just know that slowly but surely, things will start to "click". You'll start to find routines that keep you organzied. You'll start to learn the flow of your unit. You'll start to become a part of the team, instead of the newbie. Pretty soon, you'll be helping out the newbies yourself :)