3 months in and feeling incompetent

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Hi Everyone!

Just joined this forum after being a longtime-lurker. So I started my first nursing job about three months ago on an Oncology/MedSurg floor after graduating with my BSN last May. I work evening shift and overall I have been surviving through each night by giving the basic care to my assigned patients(administering meds, keeping track of intake outputs, calling doctor for orders), but I feel that I haven't progressed at all with my knowledge level. In fact I actually think I'm getting worse than I was during nursing school, that is, I'm forgetting basic protocols and procedures. For instance, in school I memorized the steps for the insertion of a foley catheter, maintaining sterile technique, etc. But yesterday I was being directed by another relatively new grad nurse on the insertion of my first "real" catheter and..let's just say there were discrepancies.

I've noticed this in a lot of areas, such as changing IV tubing every 72 hours, scrubbing hubcaps for 15 seconds, maintaining isolation precautions, etc, etc. I realize the real world is not as perfect as the nursing world.

While I am getting a lot of real-world experience, I worry that I am losing basic and proper nursing knowledge. I am developing some bad habits because there is always a rush for time. My biggest discomfort is that when I am taking care of my patients, I don't feel that I fully know how to best care for the patients or know the patient plan. Such as if a patient is admitted for pancreatitis, I don't know the standard treatment plan and can't anticipate what may be needed in the future. As a result my report to the next shift sounds sloppy and undirected. I don't have time to look and analyze all the meds that the patient is getting throughout the day, mostly only the ones on my shift. Basically all I can really do is give the scheduled meds and do basic assessments as ordered by the computer system. Another piece is lab values. I almost never look at lab values because the doctors and nurses during the day shift have already looked at them and ordered the necessary interventions. Even if I did look at them, I wouldn't be able to understand them. If I am giving blood during my shift though, I would look at the H&H. A lot of the times I also have no idea why a patient is getting a certain antibiotic, whether it is for prophylaxis, improve kidney function, or what antibiotic is for which infection.

As a nurse I think I should know these details, but most of the nurses on my floor don't either so I can't get answers to certain questions. Doctors will order stuff and not let us know why something is being started. Perhaps this is just the nature of the nursing environment, but I want to do my job well and understand all the little actions I'm giving.

So that's my rant...is there any advice you guys can provide for me on how to improve my skills and knowledge base? I am already planning on posting questions here every so often.

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You are only 3 months into the real world of nursing. Give yourself time and learn something every day. If you don't know the answer at least know where to look for the answer. It will all begin falling into place. As far as abts go your job isn't to order the abt only to know what it does and side effects. Also need to know results of cultures and sensitivities and if the abt ordered is effective against the bug you are fighting. Besides that, do your best to practice the way you were taught.

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Specializes in MICU, SICU, CICU.

You are right where should be, learning to complete the tasks and time management that the position requires.

Making sure that your patients receive all of their meds and good care is a great responsibility., so don't sell yourself short.

You are going to start recognizing the same scenarios over and over, and in time you will be more of a thinker. Realistically, it will be a couple years until you start feeling proficient.

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Specializes in OR, Nursing Professional Development.

There is a big difference in being a nursing student and being a practicing nurse, and the transition comes with a bit of a reality shock. There is a forum just for those in their first year of nursing: https://allnurses.com/first-year-after/ where you might find some suggestions and tips for making that transition.

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Specializes in Pediatrics, Emergency, Trauma.

I am going to echo what other posters have stated; the transition to being a student to novice nurse is a HUGE learning curve; don't expect that after a mere three months you are supposed to "know"; it takes YEARS to know, and even then, have the expectation that you STILL don't know everything.

Search here on AN and find brain sheets to help you organize what nursing care needs to be completed; also, take time to self study the patients you encounter as well; it helps to provide a good knowledge base and the next pt encounter in the further with a similar diagnoses, you will have an idea.

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Specializes in Cardiac, Home Health, Primary Care.

As PP's have said find a brain sheet! Make your own with your needs. I made my own specifically for the tele unit I was on. I had basic info, allergies, quick PMH, few labs, my assessment, etc. and left an area for notes. As I charted stuff I highlighted it. Highlighted = charted. It was easy for me to keep up with myself that way.

Also keep a little mini notebook around and jot down things you want to look up. Or take your brain sheet home for a specific patient (with personal info cut off of course)...then you can take a few minutes and look up pancreatitis, this antibiotic, that medicine, etc.

And it takes a WHILE to get all of the meds down. I'll admit in the hospital I knew very BASIC stuff pharm wise. I went home health and was finally able to take the time to look stuff up when patients asked me questions and I'm THANKFUL for the experience. There just isn't that time in acute care.

I do think a lot of Pyxis's (plural of Pyxis??) and charting systems may have build in catalogs of pharm info. Mine did if I remember right. You might ask or call the pharmacy or computer people and ask if there is.

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Specializes in ER.

I've been in nursing 25 years and have yet to see one person scrub a hubcap for 15 seconds. One person scrubbed for 5 seconds when she first accessed that hub during her shift, otherwise everyone has been 2-3 seconds. It may be perfect practice, but it just doesn't happen. Cross that off your worry list.

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Specializes in ICU / PCU / Telemetry / Oncology.

It's only been 3 months!! Chill pill!

The real world is definitely not the nursing world. And you don't have to memorize steps to put in a Foley, you just do it along with someone and you will always have help. Eventually that kind of stuff will click and you will always know it going forward.

Sent from my iPad using allnurses

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Specializes in LTC, Rural, OB.

Are you asking your more experienced fellow nurses questions that you have? I am six months in and I have found I am able to ask my 30 year, 40 year veteran nurses questions whenever I work with them. They have so much information to share it is amazing. Also definitely use a brain, I have been horrible about using mine until recently when our census tripled and it was hard to juggle the 6 patients plus ERs that we have (we're a small rural hospital).

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Specializes in Rehabilitation,Critical Care.

Graduated in May 2014, started working as a nurse July 2014:

2 medication errors done-not FATAL

2 patient fell on my shift-NOT FATAL

Ask a million questions every shift-NOT FATAL

Moments were I felt like I was a headless chicken: done so many times

AND COUNTING.....................

Always tell yourself to STOP AND THINK!!!!!!!!!!!

PAUSE PAUSE PAUSE!!!!!

if you don't know a med, look at the link on your computer where you can access a quick info about the med

I have found it helpful to go to work 30 minutes before shift to glance through my patients profile ie labs,meds, doctors orders etc etc. i and o, vital signs the past few hours....

Sometimes, I ask my patients too about certain infos that I don't know about them. Some are very good historians.

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Same position it may be a phase though. I fell this is the best thing to do and learn as much as you can. I'm at a facility that I didn't receive proper orientation but everyday I'm trying to learn well every night. There is a post that gives great advice for new orients on this site it should be in the top right on the "popular" tab called 50 things nurses need to know about orientation.

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Thank you for your feedback! It's really nice to get responses and maks me feel there is hope in this world lol.

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