New Job - Confidence Low

[jva13]

I've been an RN for about a year and a half most recently working in an ER. Oncology Nursing is the reason I went into nursing and recently I scored my dream job in an outpatient setting. However, I'm completely overwhelmed with all new medications I'm learning and I feel like a new grad all over again. It's starting to affect my basic nursing skills - It's like I'm thinking so much about new meds, side effects, labs, etc... that I'm becoming all thumbs when working a pump and piggyback lines. When I make mistakes like that it totally kills my confidence which then leads to blank stares when trying to answer my preceptor's questions - and the cycle repeats itself. I know what skills I already have as well as what I need to work on, but it feels like I'm trying to climb out of quicksand every shift. Everyday is a new day and I'm going to continue to work as hard as I can and keep studying. I guess I'm just looking for words of encouragement from some of you seasoned vets... Thanks

[SC_RNDude]

I wouldn't say I'm a seasoned vet, but I have changed specialties. And, I also felt like I was starting over again. I just reminded myself that I once got through my first new-grad job on a crazy unit, and that I was able to become competent at that job without have a mental breakdown and without killing anyone. When I thought back on that, then I knew that I would eventually get there again.

Good luck!

[SierraBravo]

Here's the good news, you already have all of the fundamental skills and knowledge as a nurse. Obviously working in the ED is very different than working in oncology, so give yourself a break and realize that it's going to take a little bit to get accustomed to your new work environment.

[jackson122]

I, too, will be beginning a new career in Oncology in an outpatient setting. I've been an ER nurse for 6 years and am very nervous about this transition, although I'm stoked about the hours and change of pace. I wish you the best of luck and bet that you'll end up just fine.

[RADIATION_RN]

Welcome to oncology! I am in outpatient oncology also but in the radiation side of it. Every new specialty takes time to gain confidence. My outlook is that as nurses, we never stop learning and we will learn new things everyday.

Helpful tip which helped me, investing in the Core Curriculum for Oncology Nursing book. Great book that covers everything an oncology nurse needs to know. Of course you can only learn so much from a book, the majority of your knowledge will come from on the job. We've all been there and it will get more familiar with everything!

[natectio]

I've worked in inpatient heme for over five years administering a ton of chemo everyday. What you need to understand is that learning these new meds and chemo administration techniques will take time. Don't allow yourself to feel rushed or hurried. Mistakes are going to happen, and you truly haven't failed until you stop learning from those mistakes.

If you're the organized type I would reccomend making a spreadsheet of the most common chemo meds you might administer and keep it in your pocket or locker. After time you might have those meds committed to memory.

Don't be too hard on yourself. Anything worth while will always take time and dedication. :)

[LevitateMe, RN]

I have been in oncology 3 years. At first I was so scared I was going to make a mistake. The first thing I did was make a list of all the IV drugs we used and labeled how fast they were run. I also memorized a drip rate formula because we do not usually use pumps. Then as I got comfortable with run times, I made note of the order drugs HAD to be given. For example we always do carbo after Taxol. ect. Now those things are in my head. Next I tried to memorize drug specific side effects, like camptosar and diarrhea, oxaliplatin and cold sensitivity. This way when someone had a weird reaction I could quickly find the culprit. Now (even though I often feel like i dont know enough or lack a little confidence here and there) I am much more comfortable and able to quickly grab this info from my brain.

LONG STORY SHORT: *take your time* (every mistake I've made was because I felt like i had to rush), do everything with purpose (check your names/DOBS/Drug orders), make lists and refer to them when you need to and know that mistakes may happen but you have to learn from them. And above all be honest when you screw up. the quicker a mistake is fixed the better the outcome will be.

I hate to see someone try and cover up a mistake so they arent blamed. (that was just venting, sorry )

And know that it will all come to you eventually! I'd say it took most of us about 6 months?

Good luck!

[Gooselady, BSN, RN]

I'm moving to private duty, but just resigned from a medical oncology position after six years. I'd done psych all the time before, so as for feeling like a new grad, yeah. That "I'm a complete novice" feeling is understandable, but you aren't a complete novice.

That said you are still a relatively new nurse. It takes years to become confident and appropriately so. You are still very much a learner, and that is OK, it's how it's supposed to be.

But I remember how hard I was on myself during those first years. I see you plaguing yourself and ratcheting up your anxiety, which is what is causing you to go 'blank' and feel like a complete moron.

I've had talks with new nurses about this anxiety, probably because I've never forgotten it, and never lost my soft spot for people going through this. Your anxiety is using YOU, rather than you using it, which is how it usually starts. You need some insight into how you are THINKING about yourself while you are doing your job. If you are anything like I was (and still am though less so), you call yourself names on the inside and if you don't execute something perfectly as if you were born doing it, you call yourself a failure. Worse still is to IMAGINE that your co-workers are thinking the same thing. It's really tough.

First, be accepting of yourself as a LEARNER and relatively new to nursing period. New nurses are great!! They're fantastic! No one expects you to know what you don't know. And stand up for yourself as a newish nurse, you have a right to be new. No one was born flushing central lines and spouting how to handle a Rituxan reaction.

It's more important to give yourself a break as a person right now because all that anxiety you're kicking up actually prevents you from learning and performing. Handle that anxiety, be kind to yourself, ignore the pretenders, raise an eyebrow. You are important and within six months you'll be looking back on this (with relief!). Time is your friend. No one is cracking a bullwhip except maybe you :) Yeah, we're hard on ourselves, it's what makes us so good at what we do, eventually.

[Tree5981, ADN, BSN, MSN]

I felt this exact same way when I started oncology. The drugs are overwhelming and it is a lot of information to take in. Just give yourself time to get used to it and slowly over time you will be surprised how much you learn. For me, the best thing that helped me was just taking it one patient at a time. I was able to better remember the regimens, side effects, and diagnosis when I related it to a specific person. When I remembered that specific patient it helped me to remember information about their treatment plan and the side effects they had with it. Hang it there, it gets better I promise!

Tree